Lloberes P, Montserrat J M, Ascaso A, Parra O, Granados A, Alonso P, Vilaseca I, Rodriguez-Roisin R
Servei de Pneumologia i Al. lèrgia Respiratoria, Hospital Clinic, Universitat de Barcelona, Spain.
Thorax. 1996 Oct;51(10):1043-7. doi: 10.1136/thx.51.10.1043.
Laboratory full polysomnography (PSG) is considered to be the gold standard for the diagnosis of the sleep apnoea/hypopnoea syndrome (SAHS), but it is expensive and time consuming. A study was undertaken to evaluate the diagnostic usefulness of a partially attended night time respiratory recording (NTRR) and a clinical questionnaire in patients with suspected SAHS in comparison with full PSG.
Seventy six patients (54 men) of mean (SD) age 51 (11.5) years with a body mass index of 31 (5.7) kg/m2 were studied at random on two different nights with full PSG at the sleep laboratory and with NTRR on a respiratory ward. NTRR records oximetry, airflow, chest and abdominal motion. All signals were continuously displayed on a computer screen throughout the night and respiratory events were scored automatically the following morning. All patients completed a clinical questionnaire.
Mean values of the apnoea/hypopnoea index (AHI) using NTRR were lower than those obtained with full PSG (22.7 (2.4) versus 32.2 (3) events/hour) which was mainly due to underrecognition of hypopnoeas. Sensitivity and specificity of NTRR for the diagnosis of SAHS were 82% and 90%, respectively, taking as reference AHI > 10 on full PSG (AHI-PSG > 10). The mean (+/-2SD) difference in AHI between the two methods was 9.6 (range -5.4-24.6) (95% confidence interval 6.2 to 13). Symptoms of witnessed apnoeas, impotence, the overall clinical impression of a trained physician, and a neck size over 40 cm were significantly more prevalent in patients with AHI-PSG of > 10, but impotence was the only clinical feature significantly more prevalent in patients with false negative compared with true negative NTRR results that helped to distinguish patients with NTRR < 10 but AHI-PSG > 10.
NTRR is a helpful and easy complementary diagnostic tool in clinical practice because it detects patients with moderate to severe SAHS reasonably well and therefore can be useful for confirming a diagnosis of SAHS and also for treatment decisions. It is suggested that patients with suspicion of SAHS should be initially studied by NTRR. When NTRR is negative, a full PSG should be performed if witnessed apnoeas, impotence, systemic hypertension, ischaemic heart disease, and a trained physician's clinical impression of SAHS are present.
实验室全夜多导睡眠图（PSG）被认为是诊断睡眠呼吸暂停/低通气综合征（SAHS）的金标准，但它昂贵且耗时。本研究旨在评估部分参与的夜间呼吸记录（NTRR）和临床问卷对疑似SAHS患者的诊断价值，并与全夜PSG进行比较。
76例患者（54例男性），平均（标准差）年龄51（11.5）岁，体重指数为31（5.7）kg/m²，在两个不同的夜晚分别进行研究，一晚在睡眠实验室进行全夜PSG，另一晚在呼吸病房进行NTRR。NTRR记录血氧饱和度、气流、胸部和腹部运动。所有信号在整个夜间持续显示在电脑屏幕上，呼吸事件于次日早晨自动评分。所有患者均完成一份临床问卷。
使用NTRR测得的呼吸暂停/低通气指数（AHI）平均值低于全夜PSG测得的值（分别为22.7（2.4）次/小时和32.2（3）次/小时），这主要是由于对低通气的识别不足。以全夜PSG的AHI>10（AHI-PSG>10）为参考，NTRR诊断SAHS的敏感性和特异性分别为82%和90%。两种方法测得的AHI平均（±2标准差）差值为9.6（范围-5.4至24.6）（95%置信区间6.2至13）。目睹呼吸暂停、阳痿、经培训医生的总体临床印象以及颈围超过40 cm等症状在AHI-PSG>10的患者中更为普遍，但阳痿是唯一在NTRR结果为假阴性的患者中比真阴性患者更为普遍的临床特征，有助于区分NTRR<10但AHI-PSG>10的患者。
NTRR是临床实践中一种有用且简便的辅助诊断工具，因为它能较好地检测出中度至重度SAHS患者，因此可用于确诊SAHS以及指导治疗决策。建议对疑似SAHS的患者首先进行NTRR检查。当NTRR结果为阴性时，如果存在目睹呼吸暂停、阳痿、系统性高血压、缺血性心脏病以及经培训医生对SAHS的临床印象，则应进行全夜PSG检查。
