Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events
Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events
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DOI：
10.5664/jcsm.2172
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发表时间：
2012-01-01
影响因子：
4.3
通讯作者：
Tangredi, Michelle M.
中科院分区：
文献类型：
--
作者：
Berry, Richard B.;Budhiraja, Rohit;Tangredi, Michelle M.
美国睡眠医学学会（AASM）睡眠呼吸暂停定义工作组审查了2007年AASM评分和睡眠及相关事件手册中呼吸事件评分的现行规则，以确定是否需要修订。该工作组的目标是（1）澄清和简化当前的评分规则，（2）审查与评分规则相关的新监测技术的证据，（3）争取成人和儿科规则之间更大的一致性。工作组审查了2007年发表的AASM呼吸事件评分可靠性和有效性系统综述中引用的证据，以及自该出版以来文献中出现的相关研究。考虑到已发表证据的局限性，采用共识过程来制定大多数工作组关于修订的建议，工作组就诊断和气道正压（PAP）滴定多导睡眠图期间用于检测呼吸暂停和呼吸不足的推荐和替代传感器提出了建议。如果推荐的传感器失效或信号不准确，则使用替代传感器。PAP设备流量信号是PAP滴定研究期间检测呼吸暂停、呼吸不足和呼吸努力相关觉醒（RERA）的推荐传感器。还规定了用于记录（显示）鼻压信号的适当滤波器设置，以促进吸气平坦化的可视化。呼吸感应体积描记（RIP）信号被指定用作呼吸暂停和呼吸不足检测的替代传感器。工作组就成人和儿科患者使用相同传感器达成共识，但以下情况除外：（1）潮气末PCO 2信号可以用作仅用于儿童呼吸暂停检测的替代传感器，和（2）聚偏氟乙烯（PVDF）带可用于监测呼吸努力（胸腹带），并作为一种替代传感器，用于检测呼吸暂停和呼吸不足（PVDFsum）仅在成人。当使用口鼻热传感器（诊断研究）、PAP设备流量（滴定研究）或替代呼吸暂停传感器，峰值信号偏移下降>=事件前基线的90%时，对成人呼吸暂停进行评分，持续>= 10秒。当使用鼻压（诊断研究）、PAP装置流量（滴定研究）或替代传感器的峰值信号偏移下降>=事件前基线的30%时，对成人呼吸不足进行评分，持续>= 10秒，与>= 3%的动脉氧去饱和或觉醒相关。阻塞性或中枢性呼吸不足评分现在列为可选，并列出了推荐的评分规则。在儿童中，使用口鼻热传感器（诊断研究）、PAP设备流量（滴定研究）或替代传感器，当峰值信号偏移下降>=事件前基线的90%时，对呼吸暂停进行评分;并且事件符合阻塞性、混合性或中枢性呼吸暂停的持续时间和呼吸努力标准。当事件符合呼吸暂停的标准，在整个事件中没有吸气努力，并且满足以下至少一项时，对儿童进行中枢性呼吸暂停评分：（1）事件持续时间>= 20秒，（2）事件与觉醒或>= 3%氧饱和度下降相关，（3）（仅1岁以下婴儿）事件与心率降低至低于50次/分钟至少5秒或低于60次/分钟15秒相关。当使用鼻压（诊断研究）、PAP设备流量（滴定研究）或替代传感器的峰值信号偏移下降>=事件前基线的30%时，对儿童进行呼吸不足评分，持续时间>= 2次呼吸，并伴有>= 3%的氧饱和度下降或觉醒。在儿童和成人中，动脉PCO 2的替代物是潮气末PCO 2或经皮PCO 2（诊断研究）或经皮PCO 2（滴定研究）。对于成人，当动脉PCO 2（或替代物）> 55 mm Hg>= 10分钟或动脉PCO 2（或替代物）增加>= 10 mm Hg（与清醒仰卧值相比）至超过50 mm Hg>= 10分钟时，对睡眠换气不足进行评分。对于儿科患者，当动脉PCO 2（或替代物）> 50 mm Hg且> 25%的总睡眠时间时，则对换气不足进行评分。在成人中，当满足以下两项时，对Cheyne-Stokes呼吸进行评分：（1）存在>= 3次连续中枢性呼吸暂停和/或中枢性呼吸不足的发作，间隔为呼吸振幅的渐强和渐弱变化，周期长度至少为40秒（通常为45至90秒），和（2）每小时有五次或更多次与渐强相关联的中枢性呼吸暂停和/或中枢性呼吸不足，在至少2小时的监测中记录到渐强呼吸模式。
The American Academy of Sleep Medicine (AASM) Sleep Apnea Definitions Task Force reviewed the current rules for scoring respiratory events in the 2007 AASM Manual for the Scoring and Sleep and Associated Events to determine if revision was indicated. The goals of the task force were (1) to clarify and simplify the current scoring rules, (2) to review evidence for new monitoring technologies relevant to the scoring rules, and (3) to strive for greater concordance between adult and pediatric rules. The task force reviewed the evidence cited by the AASM systematic review of the reliability and validity of scoring respiratory events published in 2007 and relevant studies that have appeared in the literature since that publication. Given the limitations of the published evidence, a consensus process was used to formulate the majority of the task force recommendations concerning revisions.The task force made recommendations concerning recommended and alternative sensors for the detection of apnea and hypopnea to be used during diagnostic and positive airway pressure (PAP) titration polysomnography. An alternative sensor is used if the recommended sensor fails or the signal is inaccurate. The PAP device flow signal is the recommended sensor for the detection of apnea, hypopnea, and respiratory effort related arousals (RERAs) during PAP titration studies. Appropriate filter settings for recording (display) of the nasal pressure signal to facilitate visualization of inspiratory flattening are also specified. The respiratory inductance plethysmography (RIP) signals to be used as alternative sensors for apnea and hypopnea detection are specified. The task force reached consensus on use of the same sensors for adult and pediatric patients except for the following: (1) the end-tidal PCO2 signal can be used as an alternative sensor for apnea detection in children only, and (2) polyvinylidene fluoride (PVDF) belts can be used to monitor respiratory effort (thoracoabdominal belts) and as an alternative sensor for detection of apnea and hypopnea (PVDFsum) only in adults.The task force recommends the following changes to the 2007 respiratory scoring rules. Apnea in adults is scored when there is a drop in the peak signal excursion by >= 90% of pre-event baseline using an oronasal thermal sensor (diagnostic study), PAP device flow (titration study), or an alternative apnea sensor, for >= 10 seconds. Hypopnea in adults is scored when the peak signal excursions drop by >= 30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative sensor, for >= 10 seconds in association with either >= 3% arterial oxygen desaturation or an arousal. Scoring a hypopnea as either obstructive or central is now listed as optional, and the recommended scoring rules are presented. In children an apnea is scored when peak signal excursions drop by >= 90% of pre-event baseline using an oronasal thermal sensor (diagnostic study), PAP device flow (titration study), or an alternative sensor; and the event meets duration and respiratory effort criteria for an obstructive, mixed, or central apnea. A central apnea is scored in children when the event meets criteria for an apnea, there is an absence of inspiratory effort throughout the event, and at least one of the following is met: (1) the event is >= 20 seconds in duration, (2) the event is associated with an arousal or >= 3% oxygen desaturation, (3) (infants under 1 year of age only) the event is associated with a decrease in heart rate to less than 50 beats per minute for at least 5 seconds or less than 60 beats per minute for 15 seconds. A hypopnea is scored in children when the peak signal excursions drop is >= 30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative sensor, for >= the duration of 2 breaths in association with either >= 3% oxygen desaturation or an arousal. In children and adults, surrogates of the arterial PCO2 are the end-tidal PCO2 or transcutaneous PCO2 (diagnostic study) or transcutaneous PCO2 (titration study). For adults, sleep hypoventilation is scored when the arterial PCO2 (or surrogate) is > 55 mm Hg for >= 10 minutes or there is an increase in the arterial PCO2 (or surrogate) >= 10 mm Hg (in comparison to an awake supine value) to a value exceeding 50 mm Hg for >= 10 minutes. For pediatric patients hypoventilation is scored when the arterial PCO2 (or surrogate) is > 50 mm Hg for > 25% of total sleep time. In adults Cheyne-Stokes breathing is scored when both of the following are met: (1) there are episodes of >= 3 consecutive central apneas and/or central hypopneas separated by a crescendo and decrescendo change in breathing amplitude with a cycle length of at least 40 seconds (typically 45 to 90 seconds), and (2) there are five or more central apneas and/or central hypopneas per hour associated with the crescendo/decrescendo breathing pattern recorded over a minimum of 2 hours of monitoring.