Utility of the bispectral index for assessing natural physiological sleep stages in children and young adults
Utility of the bispectral index for assessing natural physiological sleep stages in children and young adults
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DOI：
10.1007/s10877-015-9800-x
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发表时间：
2016-12-01
影响因子：
2.2
通讯作者：
Fauroux, Brigitte
中科院分区：
文献类型：
--
作者：
Benissa, Mohamed-Rida;Khirani, Sonia;Fauroux, Brigitte
多导睡眠图(PSG)是分析睡眠结构的黄金标准，但在常规实践中并不总是可用的，因为它对患者来说既耗时又麻烦。脑电双频指数(BIS)是用来量化全身麻醉深度的，可作为评估自然睡眠深度的简化工具。我们使用最新的BIS Vista监测仪客观记录年轻患者的睡眠结构，并将BIS值与PSG睡眠阶段相关联，以确定BIS阈值。入选有睡眠呼吸暂停/低呼吸综合征筛查或过度睡眠鉴别诊断的患者。同时进行过夜PSG和BIS检查。取各睡眠阶段的BIS值平均值。并区分入睡前觉醒(W)和入睡后觉醒(WASO)。信号质量指数为90%时，BIS值被丢弃。绘制ROC曲线以区分不同的睡眠阶段。入选患者12例，年龄5.7~29.3岁。W期、WASO期、N1期、N1期、N3期和R期的BIS值分别为83+/-A8、76+/-A12、77+/-A11、70+/-A10、43+/-A10和75+/-A10。BIS未能区分W、WASO、N1和R阶段。BIS值为73(Auc=0.784，p<；0.001)，敏感性低(75%)，特异性差(%)。诊断N3期的BIS阈值为55(AUC=0.964，P<；0.001)，敏感性为87%，特异性为93%。BIS诊断N3期具有令人满意的敏感性和特异性，但无法区分REM睡眠和觉醒。BIS结合下巴肌电和/或眼电的进一步研究可能是有意义的。
Polysomnography (PSG) is the gold standard for the analysis of sleep architecture but is not always available in routine practice, as it is time consuming and cumbersome for patients. Bispectral index (BIS), developed to quantify the deepness of general anesthesia, may be used as a simplified tool to evaluate natural sleep depth. We objectively recorded sleep architecture in young patients using the latest BIS Vista monitor and correlated BIS values with PSG sleep stages in order to determine BIS thresholds. Patients, referred for the screening of sleep apnea/hypopnea syndrome or differential diagnosis of hypersomnia were recruited. Overnight PSG and BIS were performed simultaneously. BIS values were averaged for each sleep stage. Pre-sleep wakefulness (W) and wake after sleep onset (WASO) were also differentiated. BIS values were discarded for a signal quality index < 90 %. ROC curves were plotted to discriminate sleep stages from each other. Twelve patients (5.7-29.3 years old) were included. Mean BIS values were 83 +/- A 8, 76 +/- A 12, 77 +/- A 11, 70 +/- A 10, 43 +/- A 10, and 75 +/- A 10 for W, WASO, N1, N2, N3 and R (REM) stages, respectively. BIS failed to distinguish W, WASO, N1 and R stages. BIS threshold that identified stage N2 was < 73 (AUC = 0.784, p < 0.001) with low sensitivity (75 %) and poor specificity (64 %). BIS threshold that identified stage N3 was < 55 (AUC = 0.964, p < 0.001) with an 87 %-sensitivity and a 93 %-specificity. BIS identified stage N3 with satisfactory sensitivity and specificity but is limited by its inability to distinguish REM sleep from wake. Further studies combining BIS with chin electromyogram and/or electrooculogram could be of interest.