便携式睡眠监测仪对阻塞性睡眠呼吸暂停低通气综合征的诊断价值分析

摘要

Objective To evaluate the diagnostic value of portable monitor device (PMD) in potential obstructive sleep apnea hypopnea syndrome (OSAHS) patients.Methods All patients met the inclusion criteria were asked to finish the questionniar and underwent anthropometric measurements, and then completed polysomnography(PSG) test and PMD test simultaneously.The correlation between AHI-PMD and AHI-PSG, between MinSaO2-PMD and MinSaO2-PSG were analyzed by Spearman analysis.T test was used to compare the correlation coefficient between the two groups;ROC analysis was used to evaluate the sensitivity and specificity of PMD in diagnosis of OSAHS, and got the Cut-off value between moderate and severe OSAHS and mild OSAHS.Results Through PSG test, of all the 111 cases, including 4 simple snoring cases, accounting for 3.6％, OSAHS patients with 107 cases, accounting for 96.4％ which including 11 patients (9.9％) with mild, 17 patients(15.3％) with moderate, 79 patients(71.2％) with severe.The correlation of AHI-PMD and AHI-PSG between moderate and severe OSAHS patients was stronger than simple snoring and mild OSAHS patients.The coefficient test between the two groups was statistically significant (P =0.026).The correlation of MinSaO2-PMD and MinSaO2-PSG was statistically significant (P ＜ 0.001), the correlation of MinSaO2-PMD and MinSaO2-PSG between moderate and severe OSAHS group and snoring and mild OSAHS group was not statistically significant(P =0.270).A statistically significant correlation between AHI-PMD and AHI-PSG was found(P ＜ 0.001).PMD had a sensitivity and specificity of 96.9％ and 86.7％, respectively (AUC =0.990, 95％ CI 0.970-1.000).The cut-off value between moderate and severe OSAHS and mild OSAHS was AHI-PMD ≥ 12 times/h.Conclusion PMD had a satisfactory sensitivity and specificity for diagnosing and judging the severity of moderate and severe OSAHS.%目的 探讨便携式睡眠监测仪(portable monitor device,PMD)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)可疑患者的诊断价值及可行性分析.方法 确定受试对象的纳入标准;采用统一调查表对夜间打鼾的受试者进行问卷调查及简单体格检查,并对111例可疑OSAHS患者进行7h多道睡眠监测(PSG)和便携式睡眠监测;对PMD检测所得AHI指数(AHI-PMD)和PSG检测所得AHI指数(AHI-PSG)以及PMD检测所得最低血氧饱和度(MinSaO2-PMD)和PSG检测所得最低血氧饱和度(MinSaO2-PSG)的相关性采用Spearman相关性分析,采用Z检验进行组间相关系数的比较.PMD和PSG检查仪之间诊断的符合性比较采用符号秩和检验;采用ROC分析PMD对OSAHS诊断的灵敏度和特异度,并得到中、重度OSAHS与轻度OSAHS及鼾症的界值.结果 经PSG检查,111例受试对象中4例(3.6％)单纯鼾症患者,107例(96.4％) OSAHS患者.在OSAHS患者中,轻度患者11例(9.9％),中度患者17例(15.3％),重度患者79例(71.2％).总体AHI-PMD和AHI-PSG相关性有统计学意义(r =0.889,P＜0.001),中、重度OSAHS患者的AHI-PMD和AHI-PSG相关性比单纯鼾症及轻度OSAHS患者强,两组的相关系数检验差异有统计学意义(P =0.026).总体MinSaO2-PMD和MinSaO2-PSG相关性有统计学意义(P＜0.001),中、重度OSAHS组的MinSaO2-PMD和MinSaO,-PSG与单纯鼾症及轻度OSAHS组比较,两组的相关系数检验差异无统计学意义(P=0.270).PMD诊断中、重度OSAHS患者的灵敏度和特异度分别为96.9％和86.7％,ROC曲线下面积为0.990(95％ CI为0.970 ～1.000).中、重度OSAHS与轻度OSAHS及鼾症的界值是12次/h.结论 PMD对OSAHS诊断的灵敏度和特异度较高,可用于OSAHS的诊断及病情程度的判断.