Scoring criteria for portable monitor recordings: a comparison of four hypopnoea definitions in a population-based cohort
Scoring criteria for portable monitor recordings: a comparison of four hypopnoea definitions in a population-based cohort
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DOI：
10.1136/thoraxjnl-2014-205982
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发表时间：
2015-11-01
期刊：
影响因子：
10
通讯作者：
Heinzer, Raphael
中科院分区：
文献类型：
--
作者：
Vat, Sopharat;Haba-Rubio, Jose;Heinzer, Raphael
原理有限通道便携式监护仪(PM)越来越多地被用作多导睡眠图(PSG)的替代方案，用于诊断阻塞性睡眠呼吸暂停(OSA)。然而，PM录音的评分建议仍然缺乏。脉搏波幅度(PWA)下降被认为是脑电唤醒的替代物，可能会增加PM记录中呼吸事件的检测灵敏度。目的研究4种不同的低呼吸评分标准的表现，包括或不包括PWA下降作为EEG唤醒的替代物，并确定测量和报告的睡眠时间对OSA诊断的影响。使用2012年美国睡眠医学学会的标准对PSG记录进行评分，以确定呼吸暂停-低通气指数(AHI)。然后，根据不同的低呼吸标准和患者报告的睡眠时间，只使用类型3 PM设备上可用的参数来重新记录，以确定“便携式监视器AHIS”(PM-AHIS)。主要结果纳入312名受试者。总体而言，PM-AHIS与基于PSG的AHI显示出良好的一致性，尽管它倾向于略微低估它。无PWA下降的PM-AHI对>；=5/h和>；=15/h的AHI阈值诊断准确率最高(分别为94.55%和93.27%，而PWA下降分别为80.13%和87.50%)。PwA滴度与EEG觉醒之间存在显著但不明显的相关性(r=0.2，p=0.0004)。结论以3%的PwA滴度作为脑电唤醒替代指标，以低通气量标准解释PM记录，诊断准确率最高。
Rationale Limited-channel portable monitors (PMs) are increasingly used as an alternative to polysomnography (PSG) for the diagnosis of obstructive sleep apnoea (OSA). However, recommendations for the scoring of PM recordings are still lacking. Pulse-wave amplitude (PWA) drops, considered as surrogates for EEG arousals, may increase the detection sensitivity for respiratory events in PM recordings.Objectives To investigate the performance of four different hypopnoea scoring criteria, using 3% or 4% oxygen desaturation levels, including or not PWA drops as surrogates for EEG arousals, and to determine the impact of measured versus reported sleep time on OSA diagnosis.Methods Subjects drawn from a population-based cohort underwent a complete home PSG. The PSG recordings were scored using the 2012 American Academy of Sleep Medicine criteria to determine the apnoea-hypopnoea index (AHI). Recordings were then rescored using only parameters available on type 3 PM devices according to different hypopnoea criteria and patients-reported sleep duration to determine the 'portable monitor AHIs' (PM-AHIs).Main results 312 subjects were included. Overall, PM-AHIs showed a good concordance with the PSG-based AHI although it tended to slightly underestimate it. The PM-AHI using 3% desaturation without PWA drops showed the best diagnostic accuracy for AHI thresholds of >= 5/h and >= 15/h (correctly classifying 94.55% and 93.27% of subjects, respectively, vs 80.13% and 87.50% with PWA drops). There was a significant but modest correlation between PWA drops and EEG arousals (r=0.20, p=0.0004).Conclusion Interpretation of PM recordings using hypopnoea criteria which include 3% desaturation without PWA drops as EEG arousal surrogate showed the best diagnosis accuracy compared with full PSG.