Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography
Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography
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DOI：
10.1007/s11325-008-0234-2
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发表时间：
2009-08-01
影响因子：
2.5
通讯作者：
Shapiro, Colin M.
中科院分区：
文献类型：
--
作者：
Ahmadi, Negar;Shapiro, Gilla K.;Shapiro, Colin M.
本研究的目的是通过两个多导睡眠图（psg）调查呼吸暂停低通气指数（AHI），以检查AHI变异性及其对临床诊断的影响。回顾性分析193例临床睡眠患者的两夜psg，并分析AHI变异性。本研究使用了5名夜间AHI差异显著的患者的匿名记录：来自2名患者的两晚psg表示为4个个体psg；另外两人的两晚PSG被表示为从两个不同的睡眠诊所获得；最后一个病人的PSG显示为一个两晚的研究。参加联合专业睡眠学会会议的22位睡眠专家被招募来根据多导睡眠图进行诊断。他们被告知，这些PSG来自7名患者：4名是单晚PSG患者；两个人有两个psg，每个人来自不同的诊所；还有一名患者做了两晚PSG。在193名睡眠门诊患者中，21%的患者夜间PSG AHI变异性大于5。48%的患者在第一个晚上的AHI明显升高，41%的患者在第二个晚上的AHI明显升高。使用AHI bbbb15诊断标准，20% （n = 39）的患者由于一晚的低AHI而未发现睡眠呼吸暂停。此外，根据第二晚的PSG， 13%的患者有更严重的睡眠呼吸暂停分类。在这7个病例中，27-36%的睡眠专家未能识别睡眠呼吸暂停，特别是当PSG显示AHI较低时。当向睡眠专家提供两份psg的信息时，睡眠呼吸暂停诊断漏诊的发生率降低到15-18%。利用大量患者群体，本研究支持PSG呼吸变量的显著夜间变异性。当睡眠专家只提供一份PSG记录时，对一些患者的睡眠呼吸暂停的识别就会减少。临床意义是，大约13%的睡眠门诊患者可能会从第二晚的多导睡眠监测中受益。
The purpose of this study was to investigate apnea-hypopnea index (AHI) across two polysomnographies (PSGs) to examine AHI variability and impact on clinical diagnosis.Two-night PSGs of 193 sleep clinic patients were reviewed, and the AHI variability was analyzed. Anonymized records from five patients with significant night-to-night AHI variability were used in this study: the two-night PSGs from two patients were represented as four individual PSGs; the two-night PSG for two others were represented as being obtained from two different sleep clinics; the last patient's PSG was shown as a two-night study. Twenty-two sleep experts attending the Associated Professional Sleep Societies meeting were recruited to make diagnoses based on the PSGs. They were told that the PSGs were from seven patients: four with single-night PSG; two with two PSGs, each one from a different clinic; and one patient with a two-night PSG.Twenty-one percent of the 193 sleep clinic patients had a nightly PSG AHI variability of greater than 5. Forty-eight percent of all patients had a significantly higher AHI on the first night, and 41% had a significantly higher AHI on the second night. Using an AHI > 15 diagnostic criteria, sleep apnea would have been undetected in 20% (n = 39) of patients due to low AHI on one night. Furthermore, 13% of all patients had a more severe sleep apnea classification based on the second night of PSG. For the seven cases, 27-36% of sleep experts failed to identify sleep apnea especially when presented with the PSG containing the lower AHI. Incidences of missed sleep apnea diagnoses were reduced to 15-18% when information from two PSGs was presented to the sleep experts.Utilizing a large patient population, this study supports the significant night-to-night variability in PSG respiratory variables. Identification of sleep apnea in some patients is reduced when sleep experts are provided with only one PSG recording. The clinical implication is that about 13% of sleep clinic patients might benefit from a second night of PSG.