目的 探讨应用Watch-PAT便携式睡眠监测仪(简称PAT)在诊断儿童阻塞性睡眠呼吸暂停综合征(OSAS)中的临床价值.方法 采用自身平行对照临床试验设计,双盲法随机选择2013年1月至2014年12月门诊收治的50例鼾症儿童,其中3～5岁组20例,6～11岁组30例,均同时用PAT和整夜多导睡眠监测仪(PSG)监测睡眠.比较分析两种睡眠监测方法对OSAS和非OSAS儿童睡眠各参数的吻合性,以及诊断OSAS的敏感度和特异度.以PSG为参考标准,ROC曲线分析PAT诊断OSAS的敏感度和特异度.结果 6～11岁组PAT监测法检出14例OSAS,与PSG监测法一致.而3～5岁组PAT仅检出6例OSAS,PSG检出11例(x2=4.80,P＜0.05).对6～11岁组的睡眠参数分析结果显示,与非OSAS患儿比较,PAT法显示OSAS患儿Ⅲ+Ⅳ期睡眠时间[(30.5±2.4)％比(38.2±2.3)％,x2=4.31,P＜0.05]、快动眼睡眠期睡眠时间[(8.9±2.5)％比(18.3±2.1)％,x2 =4.31,P＜0.05]、睡眠总时间[(458 ±78) min比(522±56)min,=4.85,P＜0.05]和睡眠效率[(83.5±3.1)％比(93.5±3.5)％,t =3.75,P＜0.05]明显减少,Ⅰ+Ⅱ期睡眠时间[(61.5±4.4)％比(44.1±3.5)％,x2=6.07,P＜0.05]和微觉醒指数[(29.5±8.2)/h比(10.6±5.6)/h,t=3.70,P＜0.05]增多,最低氧饱和度[(82.1±6.8)％比(96.8±3.2)％,=2.56,P＜0.05]、呼吸暂停低通气指数(AHI)[(7.6±5.3)/h比(2.1±2.0)/h,=2.40,P＜0.05]、呼吸紊乱指数(RDI)[(18.2±5.1)/h比(6.5±3.9)/h,=3.85,P＜0.05]均显示差异有统计学意义.PAT监测显示OSAS患儿总睡眠时间[(458±78) min比(430±76) min,t=2.90,P＜0.05]和睡眠效率[(83.5±3.1)％比(81.9±4.3)％,t=2.45,P＜0.05]均高于PSG监测.ROC曲线分析显示,当取值AHI 5.0时,PAT监测的敏感度为0.952,特异度为0.858;AHI 7.0时,灵敏度为0.968,特异度为0.985;AHI 10时,敏感度为0.985,特异度为0.99.但取值AHI 1.0时,敏感度仅为0.852,特异度仅为0.785.结论 PAT与PSG监测结果在中重度OSAS学龄儿童中有较高的一致性,但在年幼儿有较大的差异,因此PAT可用于学龄期鼾症儿童的家庭睡眠监测筛查.
目的 探討應用Watch-PAT便攜式睡眠鑑測儀(簡稱PAT)在診斷兒童阻塞性睡眠呼吸暫停綜閤徵(OSAS)中的臨床價值.方法 採用自身平行對照臨床試驗設計,雙盲法隨機選擇2013年1月至2014年12月門診收治的50例鼾癥兒童,其中3～5歲組20例,6～11歲組30例,均同時用PAT和整夜多導睡眠鑑測儀(PSG)鑑測睡眠.比較分析兩種睡眠鑑測方法對OSAS和非OSAS兒童睡眠各參數的吻閤性,以及診斷OSAS的敏感度和特異度.以PSG為參攷標準,ROC麯線分析PAT診斷OSAS的敏感度和特異度.結果 6～11歲組PAT鑑測法檢齣14例OSAS,與PSG鑑測法一緻.而3～5歲組PAT僅檢齣6例OSAS,PSG檢齣11例(x2=4.80,P＜0.05).對6～11歲組的睡眠參數分析結果顯示,與非OSAS患兒比較,PAT法顯示OSAS患兒Ⅲ+Ⅳ期睡眠時間[(30.5±2.4)％比(38.2±2.3)％,x2=4.31,P＜0.05]、快動眼睡眠期睡眠時間[(8.9±2.5)％比(18.3±2.1)％,x2 =4.31,P＜0.05]、睡眠總時間[(458 ±78) min比(522±56)min,=4.85,P＜0.05]和睡眠效率[(83.5±3.1)％比(93.5±3.5)％,t =3.75,P＜0.05]明顯減少,Ⅰ+Ⅱ期睡眠時間[(61.5±4.4)％比(44.1±3.5)％,x2=6.07,P＜0.05]和微覺醒指數[(29.5±8.2)/h比(10.6±5.6)/h,t=3.70,P＜0.05]增多,最低氧飽和度[(82.1±6.8)％比(96.8±3.2)％,=2.56,P＜0.05]、呼吸暫停低通氣指數(AHI)[(7.6±5.3)/h比(2.1±2.0)/h,=2.40,P＜0.05]、呼吸紊亂指數(RDI)[(18.2±5.1)/h比(6.5±3.9)/h,=3.85,P＜0.05]均顯示差異有統計學意義.PAT鑑測顯示OSAS患兒總睡眠時間[(458±78) min比(430±76) min,t=2.90,P＜0.05]和睡眠效率[(83.5±3.1)％比(81.9±4.3)％,t=2.45,P＜0.05]均高于PSG鑑測.ROC麯線分析顯示,噹取值AHI 5.0時,PAT鑑測的敏感度為0.952,特異度為0.858;AHI 7.0時,靈敏度為0.968,特異度為0.985;AHI 10時,敏感度為0.985,特異度為0.99.但取值AHI 1.0時,敏感度僅為0.852,特異度僅為0.785.結論 PAT與PSG鑑測結果在中重度OSAS學齡兒童中有較高的一緻性,但在年幼兒有較大的差異,因此PAT可用于學齡期鼾癥兒童的傢庭睡眠鑑測篩查.
목적 탐토응용Watch-PAT편휴식수면감측의(간칭PAT)재진단인동조새성수면호흡잠정종합정(OSAS)중적림상개치.방법 채용자신평행대조림상시험설계,쌍맹법수궤선택2013년1월지2014년12월문진수치적50례한증인동,기중3～5세조20례,6～11세조30례,균동시용PAT화정야다도수면감측의(PSG)감측수면.비교분석량충수면감측방법대OSAS화비OSAS인동수면각삼수적문합성,이급진단OSAS적민감도화특이도.이PSG위삼고표준,ROC곡선분석PAT진단OSAS적민감도화특이도.결과 6～11세조PAT감측법검출14례OSAS,여PSG감측법일치.이3～5세조PAT부검출6례OSAS,PSG검출11례(x2=4.80,P＜0.05).대6～11세조적수면삼수분석결과현시,여비OSAS환인비교,PAT법현시OSAS환인Ⅲ+Ⅳ기수면시간[(30.5±2.4)％비(38.2±2.3)％,x2=4.31,P＜0.05]、쾌동안수면기수면시간[(8.9±2.5)％비(18.3±2.1)％,x2 =4.31,P＜0.05]、수면총시간[(458 ±78) min비(522±56)min,=4.85,P＜0.05]화수면효솔[(83.5±3.1)％비(93.5±3.5)％,t =3.75,P＜0.05]명현감소,Ⅰ+Ⅱ기수면시간[(61.5±4.4)％비(44.1±3.5)％,x2=6.07,P＜0.05]화미각성지수[(29.5±8.2)/h비(10.6±5.6)/h,t=3.70,P＜0.05]증다,최저양포화도[(82.1±6.8)％비(96.8±3.2)％,=2.56,P＜0.05]、호흡잠정저통기지수(AHI)[(7.6±5.3)/h비(2.1±2.0)/h,=2.40,P＜0.05]、호흡문란지수(RDI)[(18.2±5.1)/h비(6.5±3.9)/h,=3.85,P＜0.05]균현시차이유통계학의의.PAT감측현시OSAS환인총수면시간[(458±78) min비(430±76) min,t=2.90,P＜0.05]화수면효솔[(83.5±3.1)％비(81.9±4.3)％,t=2.45,P＜0.05]균고우PSG감측.ROC곡선분석현시,당취치AHI 5.0시,PAT감측적민감도위0.952,특이도위0.858;AHI 7.0시,령민도위0.968,특이도위0.985;AHI 10시,민감도위0.985,특이도위0.99.단취치AHI 1.0시,민감도부위0.852,특이도부위0.785.결론 PAT여PSG감측결과재중중도OSAS학령인동중유교고적일치성,단재년유인유교대적차이,인차PAT가용우학령기한증인동적가정수면감측사사.
Objective To determine the clinical value of portable sleep testing by Watch-PAT (PAT) in children with obstructive sleep apnea syndrome (OSAS).Method Fifty cases of snoring children aged 3-11 years were randomly selected to undergo the polysomnography (PSG) and PAT simultaneously at the same night.The consistency of sleep parameters in OSAS and non-OSAS children were compared with PSG as reference standard, and ROC curve analysis was performed to assess the sensitivity and specificity in the diagnosis of OSAS with PAT portable sleep monitor.Result Fourteen cases were diagnosed as OSAS in 6-11 years group by PAT and PSG.But in 3-5 years group, only six children were diagnosed as OSAS,there was significant difference between PAT and PSG (P ＜ 0.05).Among those 6-11 years old children, compared with non-OSAS, PAT study showed that Ⅲ + Ⅳ stage sleep ((30.5 ± 2.4) ％ vs.(38.2 ± 2.3)％, x2 =4.31, P＜0.05), REM sleep duration((8.9±2.5)％ vs.(18.3 ±2.1)％, x2 =4.31, P ＜ 0.05) , TST((458 ± 78) min vs.(522 ± 56) min, t =4.85, P ＜ 0.05) and sleep efficiency ((83.5 ± 3.1)％ vs.(93.5±3.5)％, t=3.75, P＜0.05)decreased, Ⅰ + Ⅱ stage sleep ((61.5±4.4)％ vs.(44.1 ± 3.5) ％, x2 =6.07, P ＜ 0.05), arousal index ((29.5 ± 8.2)/h vs.(10.6 ± 5.6)/h, t =3.70,P＜0.05), AHI ((7.6±5.3)/h vs.(2.1 ±2.0)/h, t=2.40, P＜0.05), RDI((18.2±5.1)/h vs.(6.5 ±3.9)/h, t =3.85, P＜0.05)increased in OSAS children.Furthermore, the total sleep time (TST)((458 ± 78) minvs.(430 ± 76) min, t=2.90, P＜0.05) and sleep efficiency ((83.5±3.1) ％ vs.(81.9±4.3) ％, t =2.45, P＜0.05) were higher by PAT than scored by PSG.ROC curve analysis showed the best threshold selection of AHI 5.0, the sensitivity was 0.952, the specificity was 0.858.AHI 7.0, the sensitivity was 0.968, the specificity was 0.985.AHI 10, the sensitivity was 0.985 and the specificity was 0.99, but AHI 1.0, the sensitivity was 0.852 and the specificity was 0.785.Conclusion PAT can be used at home in school age children due to the high consistency with PSG and the high compliance.
