调整快速眼动睡眠比例低的儿童的呼吸暂停低通气指数及其对阻塞性睡眠呼吸暂停诊断和严重程度的潜在影响。

Adjusting the apnea-hypopnea index in children with a low percentage of REM sleep and its potential impact on OSA diagnosis and severity.

作者信息

Alnaimi Amal, Toma Haneen, Abushahin Ahmed, Belavendra Antonisamy, Abu-Hasan Mutasim

机构信息

Department of Pediatric Medicine, Division of pulmonology, Sidra Medicine, Doha, Qatar.

Weill Cornell Medicine-Qatar, Doha, Qatar.

出版信息

J Clin Sleep Med. 2025 May 1;21(5):783-788. doi: 10.5664/jcsm.11532.

DOI:10.5664/jcsm.11532

PMID:39745439

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12048336/

Abstract

STUDY OBJECTIVES

A decrease in rapid eye movement (REM) time during polysomnography in patients with obstructive sleep apnea (OSA) can result in underestimation of apnea-hypopnea index (AHI). We propose adjusting AHI to normalized REM% in individuals with REM% ≤ 15% to avoid underdiagnosis of OSA.

METHODS

All children who completed diagnostic polysomnography from 2016-2023 with REM% of ≤ 15% of total sleep time were selected for adjustment. AHI adjustment was done by multiplying AHI by a normalization factor (20%)/REM%. Changes in OSA diagnosis and severity were evaluated before vs after adjustment. Intraclass comparison and Bland-Altman plots were used to evaluate agreement level of adjusted AHI vs nonadjusted AHI with REM AHI as the reference. value < .05 was significant.

RESULTS

Of 389 children reviewed, only 79 (20%) children had low REM% of ≤ 15%. Median (range) age was 12.8 (0.9-18) years with male/female ratio 2.3/1. Mean (standard deviation) sleep efficiency was 64.7% (12.3). Mean (standard deviation) REM% was 10.5% (3.4). Median AHI (range) before AHI adjustment was 1.7 (0-44) events/h vs 4.1 (0-74.4) events/h after AHI adjustment ( < .001). Adjusted AHI had better agreement with REM-AHI (intraclass correlation = .691; 95% confidence interval: 0.58, 0.80) than nonadjusted AHI (intraclass correlation = .485; 95% confidence interval: 0.39, 0.58). AHI adjustment changed diagnosis from normal to mild OSA in 12 (15%) patients, from mild to moderate OSA in 7 (9%) patients, and from moderate to severe OSA in 9 (11%) patients ( = .044).

CONCLUSIONS

Adjusting AHI in patients with low REM% to a normalized REM% can help avoid underdiagnosis of OSA and/or underestimation of its severity.

CITATION

Alnaimi A, Toma H, Abushahin A, Belavendra A, Abu-Hasan M. Adjusting the apnea-hypopnea index in children with a low percentage of REM sleep and its potential impact on OSA diagnosis and severity. . 2025;21(5):783-788.

摘要

研究目的

阻塞性睡眠呼吸暂停（OSA）患者多导睡眠图检查期间快速眼动（REM）时间减少可导致呼吸暂停低通气指数（AHI）被低估。我们建议将REM%≤15%的个体的AHI调整为标准化REM%，以避免OSA漏诊。

方法

选取2016年至2023年完成诊断性多导睡眠图检查且REM%占总睡眠时间≤15%的所有儿童进行调整。通过将AHI乘以标准化因子（20%）/REM%来进行AHI调整。评估调整前后OSA诊断和严重程度的变化。采用组内比较和Bland-Altman图，以REM AHI为参考，评估调整后AHI与未调整AHI的一致性水平。P值<0.05具有统计学意义。

结果

在审查的389名儿童中，只有79名（20%）儿童的REM%较低，≤15%。年龄中位数（范围）为12.8（0.9 - 18）岁，男女比例为2.3/1。平均（标准差）睡眠效率为64.7%（12.3）。平均（标准差）REM%为10.5%（3.4）。AHI调整前AHI中位数（范围）为1.7（0 - 44）次/小时，调整后为4.1（0 - 74.4）次/小时（P<0.001）。调整后的AHI与REM - AHI的一致性更好（组内相关系数 = 0.691；95%置信区间：0.58，0.80），优于未调整的AHI（组内相关系数 = 0.485；95%置信区间：0.39，0.58）。AHI调整使12名（15%）患者的诊断从正常变为轻度OSA，7名（9%）患者从轻度变为中度OSA，9名（11%）患者从中度变为重度OSA（P = 0.044）。

结论

将REM%低的患者的AHI调整为标准化REM%有助于避免OSA漏诊和/或低估其严重程度。

引用文献

Alnaimi A, Toma H, Abushahin A, Belavendra A, Abu - Hasan M. Adjusting the apnea - hypopnea index in children with a low percentage of REM sleep and its potential impact on OSA diagnosis and severity. 2025;21(5):783 - 788.