White D P, Gibb T J, Wall J M, Westbrook P R
National Jewish Center, Denver V.A. Medical Center, CO 80220, USA.
Sleep. 1995 Feb;18(2):115-26. doi: 10.1093/sleep/18.2.115.
Obstructive sleep apnea is increasingly recognized as a common and debilitating disorder. As a result, a variety of diagnostic technologies have evolved to potentially decrease cost and improve access and ease of assessment. In this study we compared the Healthdyne NightWatch (NW) System (a home sleep diagnostic methodology) to standard polysomnography (PSG) in two sleep centers. Two separate studies were completed. NW was compared to a simultaneously obtained PSG in 30 patients (IN-LAB study). Seventy additional patients were studied in both the home with NW and in the laboratory with PSG (HOME-LAB study). The NW system records eye movement, leg movement, SaO2, nasal-oral airflow, chest and abdominal wall motion, body position and heart rate on a solid state recorder, which permits sleep staging based on body and eye movement and standard respiratory assessment. For the PSG, standard paper recording techniques were used. The IN-LAB study revealed a correlation between NW and PSG for total sleep time of r = 0.72, with NW tending to score some awake time as nonrapid eye movement sleep. The correlation for apnea-hypopnea index (AHI) was r = 0.94 between systems, with a sensitivity of 100% and specificity of 63.6% at an AHI threshold of 10. The HOME-LAB study demonstrated understandably poor correlations between NW and PSG for most measures of sleep, which is likely a product of night-to-night variability in sleep, home versus laboratory effects and the differences in sleep staging methodology. However, the correlation for AHI was r = 0.92, with a sensitivity of 90.7% and a specificity of 70.4% at an AHI threshold of 10. Using a new methodology to assess agreement between diagnostic systems, we observed 78.6% diagnostic agreement between NW and PSG in the HOME-LAB study, with NW underestimating AHI 4.3% of the time and overestimating it in 17.1% of cases. This may relate to night-to-night variability in AHI or greater NW computer sensitivity to subtle hypopneas. We conclude that NW provides an accurate determination of AHI in both the home and laboratory, using limited instrumentation. The analysis time for NW is also reduced compared to PSG, and patients generally prefer the NW evaluation.
阻塞性睡眠呼吸暂停越来越被认为是一种常见且使人衰弱的疾病。因此，各种诊断技术不断发展，以潜在地降低成本、改善评估的可及性和便捷性。在本研究中，我们在两个睡眠中心将Healthdyne NightWatch（NW）系统（一种家庭睡眠诊断方法）与标准多导睡眠图（PSG）进行了比较。完成了两项独立研究。在30名患者中，将NW与同时获得的PSG进行了比较（实验室研究）。另外70名患者分别在家庭中使用NW以及在实验室中使用PSG进行了研究（家庭 - 实验室研究）。NW系统在固态记录器上记录眼动、腿部运动、血氧饱和度（SaO2）、鼻 - 口腔气流、胸壁和腹壁运动、身体位置和心率，这允许基于身体和眼动进行睡眠分期以及进行标准呼吸评估。对于PSG，使用了标准的纸质记录技术。实验室研究显示，NW与PSG在总睡眠时间上的相关性为r = 0.72，NW倾向于将一些清醒时间计为非快速眼动睡眠。两个系统之间呼吸暂停低通气指数（AHI）的相关性为r = 0.94，在AHI阈值为10时，敏感性为100%，特异性为63.6%。家庭 - 实验室研究表明，对于大多数睡眠指标，NW与PSG之间的相关性较差，这可能是睡眠的夜间变异性、家庭与实验室环境影响以及睡眠分期方法差异的结果。然而，AHI的相关性为r = 0.92，在AHI阈值为10时，敏感性为90.7%，特异性为70.4%。使用一种新的方法来评估诊断系统之间的一致性，我们在家庭 - 实验室研究中观察到NW与PSG之间的诊断一致性为78.6%，NW在4.3%的时间里低估AHI，在17.1%的病例中高估AHI。这可能与AHI的夜间变异性有关，或者与NW计算机对细微低通气的更高敏感性有关。我们得出结论，NW使用有限的仪器设备，在家中和实验室中都能准确测定AHI。与PSG相比，NW的分析时间也缩短了，而且患者通常更喜欢NW评估。
