Meyer T J, Eveloff S E, Kline L R, Millman R P
Division of Pulmonary and Critical Care Medicine, Rhode Island Hospital, Providence 02903.
Chest. 1993 Mar;103(3):756-60. doi: 10.1378/chest.103.3.756.
Night-to-night variability of apneas on overnight polymnography exists in patients with documented obstructive sleep apnea (OSA). In this study, we evaluated the possibility that this variability may be severe enough to miss the diagnosis of OSA in patients clinically at risk for the disease. We prospectively studied 11 patients who were deemed on clinical grounds to have probable OSA, but had a negative result on overnight polysomnography. Six of the 11 patients were found to have a positive second study with a significant rise in the apnea/hypopnea index (AHI) from 3.1 +/- 1.0 to 19.8 +/- 4.7 (mean +/- SEM, p < 0.01). The cause of the negative first study in these patients is unclear, but it does not seem related to risk factor pattern, sleep architecture, or test interval. The change in AHI was not found to be rapid eye movement (REM)-dependent. This study demonstrates that a negative first-night study is insufficient to exclude OSA in patients with one or more clinical markers of the disease.
在确诊为阻塞性睡眠呼吸暂停（OSA）的患者中，夜间多导睡眠图显示呼吸暂停存在夜间变异性。在本研究中，我们评估了这种变异性是否严重到足以导致临床上有患该疾病风险的患者漏诊OSA。我们前瞻性地研究了11例临床诊断可能为OSA但夜间多导睡眠图结果为阴性的患者。11例患者中有6例在第二次检查时结果呈阳性，呼吸暂停低通气指数（AHI）从3.1±1.0显著升至19.8±4.7（平均值±标准误，p<0.01）。这些患者首次检查结果为阴性的原因尚不清楚，但似乎与危险因素模式、睡眠结构或检查间隔无关。未发现AHI的变化与快速眼动（REM）相关。本研究表明，对于有一项或多项该疾病临床指标的患者，首夜检查结果为阴性不足以排除OSA。
