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ENGLISH ABSTRACT
非接触式睡眠呼吸监测仪在成人阻塞性睡眠呼吸暂停中的应用价值
薛健博
赵瑞
李静
赵龙
周兵
董霄松
韩芳
作者及单位信息
·
DOI： 10.3760/cma.j.cn112147-20210131-00088
Validation of a contact-free sleep apnea monitor in adults with obstructive sleep apnea
Xue Jianbo
Zhao Rui
Li Jing
Zhao Long
Zhou Bing
Dong Xiaosong
Han Fang
Authors Info & Affiliations
Xue Jianbo
Department of Respiratory and Critical Care Medicine, Peking University People′s Hospital, Beijing 100044, China
Zhao Rui
Department of Respiratory and Critical Care Medicine, Peking University People′s Hospital, Beijing 100044, China
Li Jing
Department of Respiratory and Critical Care Medicine, Peking University People′s Hospital, Beijing 100044, China
Zhao Long
Department of Respiratory and Critical Care Medicine, Peking University People′s Hospital, Beijing 100044, China
Zhou Bing
Department of Respiratory and Critical Care Medicine, Peking University People′s Hospital, Beijing 100044, China
Dong Xiaosong
Department of Respiratory and Critical Care Medicine, Peking University People′s Hospital, Beijing 100044, China
Han Fang
Department of Respiratory and Critical Care Medicine, Peking University People′s Hospital, Beijing 100044, China
·
DOI： 10.3760/cma.j.cn112147-20210131-00088
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摘要

目的评价非接触式睡眠呼吸监测仪在成人阻塞性睡眠呼吸暂停（OSA）患者中的应用价值。

方法本研究选取2018年7月至2019年5月因打鼾就诊于北京大学人民医院睡眠中心的成人患者，在进行多导睡眠监测（PSG）的同时使用非接触式睡眠呼吸监测仪进行监测，利用均数检验、Pearson相关系数及Bland-Altman法评估非接触式睡眠呼吸监测仪生成的呼吸事件指数（REI）与PSG生成的呼吸暂停低通气指数（AHI）之间的一致性，计算非接触式睡眠呼吸监测仪诊断OSA的敏感度和特异度，并以受试者工作特征（ROC）曲线确定其诊断OSA的最佳界值。

结果共纳入198例患者，其中男120例，女78例，年龄45.5（33.0，57.3）岁。PSG生成的AHI与非接触式睡眠呼吸监测仪的REI差异无统计学意义［15.9（4.7，40.2）次/h比16.2（6.1，40.0）次/h， P=0.381），二者显著相关（ r=0.914，P<0.05），其一致性检验的平均差-0.06次/h（95% CI：-18.44~18.31）；如以REI≥5次/h作为诊断标准，则非接触式睡眠呼吸监测仪诊断OSA的敏感度为91.2%，特异度为58.0%；以REI≥13.3次/h诊断中重度OSA的敏感度、特异度分别为90.1%，71.1%。

结论该非接触式睡眠呼吸监测仪所得REI与PSG-AHI一致性较好，可用于OSA及中重度OSA患者的筛查。

睡眠呼吸暂停，阻塞性;多导睡眠监测;非接触式睡眠呼吸监测仪
ABSTRACT

ObjectiveTo evaluate the diagnostic value of a contact-free sleep apnea monitor in Chinese adults with obstructive sleep apnea (OSA).

MethodsOne hundred and ninety-eight participants with snoring were recruited between July 2018 and May 2019 in Sleep Center of Peking University People′s Hospital, using nocturnal polysomnography (PSG) and contact-free sleep apnea monitor simultaneously. We evaluated the difference between respiratory event index (REI) generated by contact-free sleep apnea monitor and PSG-Apnea-Hypopnea Index (AHI). We calculated the sensitivity and specificity of OSA diagnosis using the contact-free sleep apnea monitor by hypothesis testing for means, Pearson correlation coefficient and Bland-Altman plots. Then, we used the receiver operating characteristic (ROC) curve to find out the best cut-off of OSA diagnosis.

ResultsPSG-AHI and the REI of contact-free sleep apnea monitor showed no statistically significant difference [15.9 (4.7, 40.2) vs. 16.2 (6.1, 40.0), P=0.381], and they were significantly correlated ( r=0.914, P<0.05), with mean difference of -0.06 (95% CI:-18.44, 18.31). The ROC curve showed that if REI ≥5 events/h was used as diagnostic criteria, the sensitivity and specificity of diagnosing OSA were 91.2% and 58.0%, respectively. The sensitivity and specificity of the contact-free sleep apnea monitor REI≥13.3 in diagnosing moderate and severe OSA were 90.1% and 71.1%, respectively.

ConclusionThe REI obtained from the contact-free sleep apnea monitor showed a good agreement with the PSG-AHI, and therefore, the contact-free sleep apnea monitor can be used for the screening of patients with moderate and severe OSA.

Sleep apnea, obstructive;Polysomnography;Contact-free sleep apnea monitor
Dong Xiaosong, Email: nc.defudabe.hpukpgnosoaixgnod
引用本文

薛健博,赵瑞,李静,等. 非接触式睡眠呼吸监测仪在成人阻塞性睡眠呼吸暂停中的应用价值[J]. 中华结核和呼吸杂志,2021,44(10)：880-885.

DOI:10.3760/cma.j.cn112147-20210131-00088

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*以上评分为匿名评价
阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）是一组因上气道塌陷导致睡眠过程中反复出现呼吸暂停或者低通气并因此引起一系列病理生理改变的临床症候群。OSA不仅可以引起夜间打鼾及白天嗜睡等症状，还可以增加心血管疾病 ［ 1 , 2 , 3 ］ 、恶性肿瘤 ［ 4 ］ 甚至猝死 ［ 5 ］ 的风险。目前认为，诊断OSA的金标准仍是在专业睡眠中心进行的整夜多导睡眠监测（polysomnography，PSG），但该方法对设备及人员要求较高且费用昂贵，难以大规模开展 ［ 6 ］ ；睡眠环境的改变和安装多种传感器也会影响患者睡眠，难以完全还原患者平日的睡眠情况。便携式睡眠监测（portable monitoring，PM）技术已被推荐为诊断中重度OSA的可替代监测技术 ［ 7 ］ ，但也需要多个导联连接，无法完全排除传感器对患者睡眠情况的影响以及导联脱落信号丢失导致的诊断不准确。
近年来，由于电子工程学技术的发展，许多新型传感器和算法被应用于睡眠监测领域，其中不乏非接触式的监测系统。研究表明，安装有压力传感器的床垫对于OSA具有较高的诊断价值，并且受试者睡眠舒适度也有较大的改善 ［ 8 , 9 , 10 ］ ；利用声压传感器对受试者呼吸运动中不同部位的声音及压力情况进行监测的Sonomat床垫在OSA诊断方面也表现出较高的可靠性 ［ 11 ］ 。智能手机除可以作为数据存储与分析系统联结外部传感器 ［ 12 , 13 ］ 外，还可以利用自身携带的扩音器、麦克风及陀螺仪收集周围环境声音及体动信号进行分析以实现对睡眠状态的监测及疾病的诊断 ［ 14 , 15 ］ 。利用低功率电磁波的雷达系统对睡眠呼吸疾病进行监测及诊断的SleepMinder也应用于临床，研究表明其在OSA诊断方面有着较高的准确性 ［ 16 , 17 ］ 。
本次研究中应用的非接触式睡眠呼吸监测仪是基于超宽带（impulse radio-ultra wide band，IR-UWB）雷达系统应用于OSA诊断的一种全新技术，其传感器系统与患者完全分离，减少了监测对患者睡眠情况的影响，但其准确性及诊断价值尚需进一步验证。本研究将非接触式睡眠呼吸监测仪与PSG进行对比，探讨其在成人OSA患者中的应用价值。
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备注信息
A
董霄松，Email： nc.defudabe.hpukpgnosoaixgnod
B

薛健博、赵瑞：受试者入组、数据收集、数据分析、论文撰写；李静、赵龙、周兵：PSG数据采集和分析；董霄松、韩芳：研究设计、研究指导、论文修改

C

薛健博, 赵瑞, 李静, 等. 非接触式睡眠呼吸监测仪在成人阻塞性睡眠呼吸暂停中的应用价值[J]. 中华结核和呼吸杂志, 2021, 44(10): 880-885. DOI: 10.3760/cma.j.cn112147-20210131-00088.

D
所有作者均声明不存在利益冲突
E
国家高技术研究发展计划 (2012AA02A604)
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