Haponik E F, Smith P L, Meyers D A, Bleecker E R
Am J Med. 1984 Oct;77(4):671-7. doi: 10.1016/0002-9343(84)90361-9.
To determine whether polysomnography is necessary to assess the presence and severity of sleep-disordered breathing, bedside observations by physicians were compared with the results of polysomnography in 37 patients with clinically suspected obstructive sleep apnea. Physician observations correlated with objective findings from polysomnography in detecting the presence of obstructive apnea (p less than 0.01), and had a high specificity and positive predictive value. The 20 patients correctly identified by clinical observation had a longer duration of apneic episodes (p = 0.02), increased severity of snoring (p = 0.02), resuscitative snoring (p less than 0.02), and paradoxic thoracoabdominal movement (p less than 0.05). However, 11 other patients with sleep-disordered breathing were not identified clinically; therefore, the sensitivity (64.5 percent) and diagnostic accuracy (70.3 percent) of brief clinical observation were low. Furthermore, the physicians' determinations of the severity of the condition on the basis of bedside estimates of disordered breathing rate, duration of episodes, and the degree of associated hemoglobin oxygen desaturation did not correlate with objective measurements. These findings suggest that a single, brief clinical observation alone is an ineffective screening procedure for detecting obstructive sleep apnea.
为了确定多导睡眠图对于评估睡眠呼吸紊乱的存在及严重程度是否必要，研究人员将医生的床边观察结果与37例临床疑似阻塞性睡眠呼吸暂停患者的多导睡眠图结果进行了比较。在检测阻塞性呼吸暂停的存在方面，医生的观察结果与多导睡眠图的客观发现相关（p小于0.01），并且具有较高的特异性和阳性预测值。通过临床观察正确识别出的20例患者的呼吸暂停发作持续时间更长（p = 0.02），打鼾严重程度增加（p = 0.02），复苏性打鼾（p小于0.02），以及反常胸腹运动（p小于0.05）。然而，临床上未识别出另外11例睡眠呼吸紊乱患者；因此，简短临床观察的敏感性（64.5%）和诊断准确性（70.3%）较低。此外，医生根据床边对呼吸紊乱频率、发作持续时间以及相关血红蛋白氧饱和度程度的估计来确定病情严重程度，这与客观测量结果不相关。这些发现表明，仅进行一次简短的临床观察对于检测阻塞性睡眠呼吸暂停是一种无效的筛查方法。
