A COMPARISON OF CLINICAL-ASSESSMENT AND HOME OXIMETRY IN THE DIAGNOSIS OF OBSTRUCTIVE SLEEP-APNEA
A COMPARISON OF CLINICAL-ASSESSMENT AND HOME OXIMETRY IN THE DIAGNOSIS OF OBSTRUCTIVE SLEEP-APNEA
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DOI：
10.1164/ajrccm/147.1.50
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发表时间：
1993-01-01
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影响因子：
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通讯作者：
SAUNDERS, NA
中科院分区：
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作者：
GYULAY, S;OLSON, LG;SAUNDERS, NA
为了确定动脉血氧饱和度（Sa（O2））的测量是否可以识别患有阻塞性睡眠呼吸暂停（OSA）的患者，对98例连续转诊评估打鼾和/或日间嗜睡的患者进行了临床评估，然后在家中进行了无监督的血氧测定和正式的多导睡眠图。临床评估确定了呼吸暂停+呼吸不足指数（AHI）大于或等于每小时15次事件的患者，敏感性为79%，特异性为50%。通过计算记录的动脉血氧饱和度下降次数进行的家庭血氧饱和度测定分析劣于临床评估。对于饱和度较基线降低2%或更高的患者，饱和度降低指数（DI）≥ 15/h识别AHI ≥ 15的患者的灵敏度为65%，特异性为74%;对于3%饱和度降低，灵敏度为51%，特异性为90%;对于4%饱和度降低，灵敏度为40%，特异性为98%。根据血氧测定数据，还计算了Sao低于90%（CT 90）的时间百分比。CT 90 ≥ 1%识别AHI ≥ 15的患者的敏感性为93%，特异性为51%;对于AHI ≥ 15的患者，最终给予经鼻持续气道正压通气（CPAP），CT 90 ≥ 1%的敏感性为100%。我们得出结论，CT 90 < 1%的家庭血氧测定实际上排除了临床显著的OSA。相反，对于4%去饱和度，DI大于或等于15的家庭血氧测定可能导致OSA：如果OSA的预测试概率为30%，则OSA的阳性预测值为83%，如果预测试概率至少为50%，则超过90%。
In order to determine whether measurement of arterial oxygen saturation (Sa(O2) could identify patients with obstructive sleep apnea (OSA), 98 consecutive patients referred for assessment of snoring and/or daytime somnolence were assessed clinically and then underwent both unsupervised oximetry in their homes and formal polysomnography. Clinical assessment identified patients with an apnea + hypopnea index(AHI) greater-than-or-equal-to 15 events per hour with a sensitivity of 79% and a specificity of 50%. Home oximetry analyzed by counting the number of arterial oxygen desaturations recorded was inferior to clinical assessment. For desaturations of 2% or more from baseline, desaturation index (DI) greater-than-or-equal-to 15 per hour identified patients with AHI greater-than-or-equal-to 15 with sensitivity 65% and specificity 74%; for 3% desaturations, sensitivity was 51% and specificity 90%; and for 4% desaturations, sensitivity was 40% and specificity 98%. From the oximetry data, the percentage of time spent at Sao, below 90% (CT90) was also calculated. CT90 greater-than-or-equal-to 1% identified patients with AHI greater-than-or-equal-to 15 with sensitivity 93% and specificity 51%; for patients with AHI greater-than-or-equal-to 15 ultimately given nasal continuous positive airway pressure (CPAP), the sensitivity of a CT90 greater-than-or-equal-to 1% was 100%. We concluded that home oximetry with CT90 < 1% practically excludes clinically significant OSA. Conversely, home oximetry with DI greater-than-or-equal-to 15 for 4% desaturations makes OSA likely: the positive predictive value for OSA is 83% if the pretest probability of OSA is 30% and over 90% if the pretest probability is at least 50%.