CAJ | 학술논문

目的探讨腕动仪结合血氧监测仪在诊断睡眠呼吸暂停低通气综合征(SAHS)中的价值.方法收集2013年12月至2014年9月期间至北京大学人民医院睡眠中心疑诊的SAHS受试者,同时记录多导睡眠记录仪(PSG)、腕动仪及血氧监测仪的开灯时间和关灯时间.腕动仪用于矫正血氧监测仪的总睡眠时间(TST).血氧监测仪所得氧减指数(ODI4)为每小时Sp02下降≥4％的次数,经腕动仪矫正时间后的ODI4命名为ODIA,用受试者工作特征(ROC)曲线评定0DI4及ODIA诊断价值及判定诊断SAHS的界值.腕动仪和血氧监测仪所得指标与PSG所得指标分别使用配对t检验或符号秩和检验进行比较.四格表法计算ODI4和ODIA的敏感度和特异度.根据PSG所得的呼吸暂停低通气指数(AHI)对SAHS进行病情分级:AHI ＜5次/h为无SAHS,5～＜15次/h为轻度,15～＜ 30次/h为中度,≥30次/h为重度.结果 213例受试者中,无SAHS者38例,轻、中、重度SAHS各有34、51、90例.与PSG相比,腕动仪在无SAHS组(P=0.408)和轻度SAHS组(P =0.949)能够准确地估测TST;在中度和重度SAHS组,腕动仪所得TST均显著低于PSG所得TST[(405±51)比(419±40) min和(399±62)比(422±60)min](均P＜0.05).在诊断SAHS中ODI4的ROC曲线下面积(AUC)为0.956,界值为5;ODIA的AUC为0.951,界值也为5.ODI4诊断轻度、中度和重度SAHS的敏感度分别为80.6％、66.7％和58.9％,特异度均为100％.经腕动仪矫正TST后,ODIA诊断轻度、中度和重度SAHS敏感度分别为84.0％、73.8％和68.9％,特异度分别为94.7％、100％和99.2％.结论腕动仪在无SAHS组和轻度SAHS组可准确估测TST.ODI4在SAHS的诊断中具有一定价值,经腕动仪矫正TST后的ODIA诊断SAHS的敏感度提高.
목적 탐토완동의결합혈양감측의재진단수면호흡잠정저통기종합정(SAHS)중적개치.방법 수집2013년12월지2014년9월기간지북경대학인민의원수면중심의진적SAHS수시자,동시기록다도수면기록의(PSG)、완동의급혈양감측의적개등시간화관등시간.완동의용우교정혈양감측의적총수면시간(TST).혈양감측의소득양감지수(ODI4)위매소시Sp02하강≥4％적차수,경완동의교정시간후적ODI4명명위ODIA,용수시자공작특정(ROC)곡선평정0DI4급ODIA진단개치급판정진단SAHS적계치.완동의화혈양감측의소득지표여PSG소득지표분별사용배대t검험혹부호질화검험진행비교.사격표법계산ODI4화ODIA적민감도화특이도.근거PSG소득적호흡잠정저통기지수(AHI)대SAHS진행병정분급:AHI ＜5차/h위무SAHS,5～＜15차/h위경도,15～＜ 30차/h위중도,≥30차/h위중도.결과 213례수시자중,무SAHS자38례,경、중、중도SAHS각유34、51、90례.여PSG상비,완동의재무SAHS조(P=0.408)화경도SAHS조(P =0.949)능구준학지고측TST;재중도화중도SAHS조,완동의소득TST균현저저우PSG소득TST[(405±51)비(419±40) min화(399±62)비(422±60)min](균P＜0.05).재진단SAHS중ODI4적ROC곡선하면적(AUC)위0.956,계치위5;ODIA적AUC위0.951,계치야위5.ODI4진단경도、중도화중도SAHS적민감도분별위80.6％、66.7％화58.9％,특이도균위100％.경완동의교정TST후,ODIA진단경도、중도화중도SAHS민감도분별위84.0％、73.8％화68.9％,특이도분별위94.7％、100％화99.2％.결론 완동의재무SAHS조화경도SAHS조가준학고측TST.ODI4재SAHS적진단중구유일정개치,경완동의교정TST후적ODIA진단SAHS적민감도제고.
Objective To explore the value of actigraphy and oximetry for diagnosing sleep apneahypopnea syndrome (SAHS).Methods Suspected SAHS subjects were enrolled from sleep center of Peking University People's Hospital between December 2013 and September 2014.Light-out and light-on were simultaneously recorded for polysomnography (PSG),actigraphy and oximetry.Actigraphy was used to correct total sleep time (TST) for oximetry.Oxygen desaturation index (ODI4),namely the times of pulse oxygen saturation (SpO2) drop≥4％ per hour,was detected by oximetry.ODIA was used instead of ODI4 with TST corrected by actigraphy.Receiver operating characteristic (ROC) curve was used for evaluating the value of ODI4 and ODIA for diagnosing SAHS and cut-off value was calculated.Paired t-test or signed rank t-test was used for data acquired using actigraphy or oximetry compared with data acquired by PSG.Sensitivity and specificity were calculated using fourfold table.Disease severity of SAHS was classified by apneahypopnea index (AHI) detected by PSG.If AHI ＜ 5/h,SAHS was not considered.5-＜ 15/h was classified as mild,15-＜ 30/h was classified as moderate and AHI ≥30/h was classified as severe.Results Among 213 SAHS subjects,38 of them were normal,34 of them were mild,51 were moderate and 90 were severe.Compared with PSG,actigraphy can correctly estimate TST in non-SAHS (P =0.408) and mild SAHS groups (P =0.949);while in moderate and severe SAHS groups,TSTs detected by actigraphy were shorter than TSTs acquired by PSG ((405 ±51) vs (419 ±40) min and (399 ±62) vs (422 ±60) min) (both P ＜ 0.05).Area under ROC curve (AUC) of ODI4 for diagnosing SAHS was 0.956 using a cut-off value of 5;the AUC of ODIA for diagnosing SAHS was 0.951 with a cut-off value of 5 as well.The sensitivity of ODI4 for mild,moderate and severe SAHS was 80.6％,66.7％ and 58.9％ respectively,all with a specificity of 100％.After adjusting TST with actigraphy,the sensitivity of ODIA for mild,moderate and severe SAHS was 84.0％,73.8 ％ and 68.9％,with specificity of 94.7％,100％ and 99.2％ respectively.Conclusions Actigraphy can correctly estimate TST in non-SAHS and mild SAHS groups.ODI4 can be used for diagnosing SAHS.After correcting TST by actigraphy,the sensitivity of ODIA is higher.