Durán Cantolla J, Esnaola Sukia S, Rubio Aramendi R, Egea Santaolalla C
Sección de Neumología, Hospital de Txagorritxu. Vitoria-Gasteiz, Alava.
Arch Bronconeumol. 1994 Aug-Sep;30(7):331-8.
The development of inexpensive tools for diagnosing sleep apnea syndrome (SAS) is a result of the high prevalence of this condition and of the high cost of polysomnograms (PS). MESAM IV is a portable device that records changes in oxygen saturation (SO2), heart rate (HR) and snoring (S). Readings can be automatic or manual, the latter in function of an events index (EI), with a graph of the three variables generated. We carried out a simultaneous study of 51 subjects suspected of having SAS who were referred to the sleep unit by the pneumology outpatient clinic. PS was interpreted manually at 30-sec intervals as recommended by the American Thoracic Society. An apnea/hypoapnea index (AHI) > or = 10/hour of sleep was used as the cutoff point for SAS. Thirty-two (63%) subjects were found to have SAS as indicated by PS. The rate of agreement between AHI and automatic analysis of SO2, HR and S was only moderate (intra-group correlation coefficients -ICC- of 0.50, 0.40, and 0.53, respectively) and was inferior to manual analysis with EI (ICC of 0.77). Assessment of diagnostic efficacy of automatic analysis in terms of sensitivity (SEN), specificity (SPE), positive predictive value (PPV) and negative predictive value (NPV) yielded the following results: SO2 (SEN 94%, SPE 26%, PPV 68% and NPV 71%), HR (SEN 59%, SPE 58%, PPV 70%, NPV 46%); S (SEN 84%, SPE 26%, PPV 66%, NPV 50%). Manual analysis (EI) gave more valid results (SEN 100%, SPE 84%, PPV 91%, NPV 100%). If patients with chronic obstructive lung disease are excluded, however, the results for automatic analysis improve: SEN 100%, SPE 91%, PPV 96%, NPV 100%. These results show that MESAM IV is of great help in diagnosing SAS, allowing better screening for identifying candidates for PS.
开发用于诊断睡眠呼吸暂停综合征（SAS）的廉价工具是由于这种疾病的高患病率以及多导睡眠图（PS）的高成本。MESAM IV是一种便携式设备，可记录血氧饱和度（SO2）、心率（HR）和打鼾（S）的变化。读数可以是自动的或手动的，后者根据事件指数（EI）进行，同时生成这三个变量的图表。我们对51名疑似患有SAS的受试者进行了同步研究，这些受试者由肺病门诊转诊至睡眠科。按照美国胸科学会的建议，PS以30秒间隔进行人工解读。睡眠呼吸暂停/低通气指数（AHI）≥10次/小时睡眠被用作SAS的截断点。PS显示32名（63%）受试者患有SAS。AHI与SO2、HR和S自动分析之间的一致性仅为中等（组内相关系数-ICC-分别为0.50、0.40和0.53），且低于EI人工分析（ICC为0.77）。从敏感性（SEN）、特异性（SPE）、阳性预测值（PPV）和阴性预测值（NPV）方面评估自动分析的诊断效能，结果如下：SO2（SEN 94%，SPE 26%，PPV 68%，NPV 71%），HR（SEN 59%，SPE 58%，PPV 70%，NPV 46%）；S（SEN 84%，SPE 26%，PPV 66%，NPV 50%）。人工分析（EI）给出了更有效的结果（SEN 100%，SPE 84%，PPV 91%，NPV 100%）。然而，如果排除慢性阻塞性肺疾病患者，自动分析的结果会有所改善：SEN 100%，SPE 91%，PPV 96%，NPV 100%。这些结果表明，MESAM IV在诊断SAS方面有很大帮助，有助于更好地筛选出PS的候选者。
