微动敏感床垫睡眠监测系统对儿童阻塞性睡眠呼吸暂停低通气综合征的诊断作用

摘要

目的 研究微动敏感床垫睡眠监测系统(micro movement sensitive mattress sleep monitoring system,MSMSMS)在诊断儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中的临床应用价值.方法 对65例由监护人代诉存在睡眠紊乱的患儿同步进行多道睡眠检测图(PSG)和MSMSMS整夜至少7h的睡眠监测.由2名专业的分析人员采用双盲法分别对PSG和MSMSMS结果进行仪器自动分析,再由工作人员对分析结果进行人工分析.比较两种方法对儿童OSAHS诊断的一致性以及对睡眠呼吸暂停低通气指数(AHI)及其他睡眠生理参数记录结果的一致性评价.结果 整夜同步记录的65例患儿中最终有61例患儿达到试验要求,该61例受试患儿中平均年龄(7.0±2.7)岁(x±s表示),最小3岁,最大13岁;男性患儿46例,女性患儿15例,体重指数(BMI)中位数[25分位数;75分位数]为16.00[14.80; 17.65] kg/m2.受试者PSG测得平均AHI为4.50[2.30;10.15]次/h,微动敏感床垫睡眠检测系统测得AHI为3.63[2.56;6.43]次/h.对所有受试者PSG和MSMSMS测得的AHI进行相关性分析(r=0.935,P＜0.01).采用Bland-Altam法对两种监测方法进行一致性评价,95.1％的数据在95.0％一致性界限之内.以AHI＞5次/h并且夜间最低血氧饱和度＜91％或者阻塞性呼吸暂停指数(obstructive apnea index,OAI)＞1次/h并且夜间最低血氧饱和度＜91％为诊断OSAHS的阳性标准,两种方法一致性检验Kappa=37.262,P=0.125,差异无统计学意义;MSMSMS检测的灵敏度为82.9％,特异度为92.3％,误诊率为7.7％,漏诊率为17.1％.结论 MSMSMS操作简单,其作为一种诊断OSAHS的工具在OSAHS患儿的诊断上有较高的可信度,其记录的AHZ与PSG有着较高的一致性.%Objective To evaluate the diagnostic value of micro-movement sensitive mattress sleep monitoring system (MSMSMS)in children with obstructive sleep apnea hypopnea syndrome.Methods Sixty-five children with the complaint of sleep disorder were collected and detected by polysomnography and micro-sensitive mattress sleep monitoring system overnight at least seven hours.The date from two instruments were analyzed by computer automatically and then modified by two professional staff double-blind separately.The data about the diagnosis of sleep breath disorder and other sleep physiology information were compared between the two groups.Results Sixty-one cases finished the study finally.The mean age of these children was (7.0 ± 2.7) and the youngest was 3 years old,maximum was 13 years old,male children 46 cases,female patients 15 cases,body mass index (BMI) median [25 quantile; 75 quantile] 16.00[14.80;17.65]kg/m2.Mean PSG measured apnea hypopnea index (AHI) was 4.50[2.30;10.15] times/h,and mean MSMSMS AHI was 3.63 [2.56 ;6.43] times/h.There was a significant correlation between PSG AHI and AHI by MSMSMS(r =0.935,P ＜0.01).A Bland-Altamplot of PSG AHI and MSMSMS AHI was also used to assess the accuracy of MSMSMS.95.1％ of the data was fallen in the 95％ consistency areas.For AHI ≥5 times/h and nighttime minimum oxygen ＜ 91％ or obstructive apnea index (OAI) ＞ 1 time/h and nighttime minimum oxygen saturation ＜ 91％ as threshold value,the MSMSMS diagnosing sensitivity and specificity were 82.9％ and 92.3％.The misdiagnosis rate and missed diagnosis rate were 7.7％ and 17.1％.Conclusions The MSMSMS offer a simple and comfortable method to monitor children's sleep.It improves the compliance in the process of sleep monitoring.Besides,as a diagnostic tool in the diagnosis of OSAHS on children has a high credibility in AHI.