ApEn和SITi用于评估阻塞性睡眠呼吸暂停低通气综合征低氧严重程度的研究

发布时间：2018-06-25 07:26

  本文选题：阻塞性睡眠呼吸暂停低通气综合征 + AHI　； 参考：《北京协和医学院》2012年硕士论文

【摘要】：背景：1、目前评估阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea Hypopnea Syndrome, OSAHS)患者睡眠期间低氧严重程度的指标最常用的有最低血氧饱和度(L02)、氧减指数(Oxygen Desaturation Index, ODI)、血氧饱和度低于90%占整个记录时间的百分比(T90%)等。但它们只能反应患者低氧的某一方面,无法反应缺氧严重程度的全貌。2、多导睡眠图(polysomnography, PSG)是诊断阻塞性睡眠呼吸暂停低通气综合征的金标准。但操作复杂,费用高,需要在睡眠实验室进行,不易普及。国外部分学者认为夜间血氧监测可初步代替PSG对高危患者行初筛检查,但具体选用那些参数目前尚有争议。 目的：研究两项新指标血氧饱和度近似熵(ApEn)和血氧受损时间指数(Saturation Impairment Time index, SITi)对于评估OSAHS患者睡眠期间低氧严重程度及诊断OSAHS的意义,并与其他参数行相关性分析,评价其临床价值。 方法：回顾性分析500位疑诊为OSAHS的患者。所有研究对象均记录人体测量学资料、6小时睡眠呼吸监测,以AHI为标准将研究对象分为正常对照、轻度、中度、重度4个亚组。1、分别比较4组中ApEn及SITi数值大小,并将其与AHI行相关性分析。此外,对ApEn、SITi与ODI、LO2、T90%行相关性分析。2、依据AHI为金标准应用ROC曲线分析及约登指数明确ApEn、SITi对于诊断OSAHS及评估低氧程度的意义。统计学分析应用SPSS16.0软件进行。 结果：500名研究对象包括男性361例(72.2%),女性139例(27.8%),平均年龄53.2±15.2岁(范围24-95岁)。1、ApEn、SITi在各个组间均有显著性差异(P0.001),随AHI增高,ApEn、SITi数值增大。进一步行两两组间比较发现ApEn在各个组间存在显著性差异(P0.001), SITi除在正常对照与轻度OSAHS组间外在其他组间均存在显著差异(P0.05)。Spearman(?)目关分析显示ApEn、SITi与AHI呈正相关(相关系数R=0.765及R=0.678, P0.01)。 ApEn、SITi与ODI、LO2、T90%存在较好的相关性。根据ROC曲线分析结果,ApEn值16.70、17.81、20.03可分别作为判断OSAHS患者缺氧轻度、中度、重度的界值,相应SITi的取值为3.685、4.055、4.445。2、依据PSG AHI≥5作为金标准,根据ROC分析结果求最佳诊断界值,在ApEn值取16.70时,其诊断OSAHS的敏感性达到69.5%,特异性达到90.3%。 结论：1、ApEn、SITi随OSAHS患者病情加重数值明显增大,与AHI、ODI、 LO2、T90%等存在一定的相关性,ApEn、SITi对于评价OSAHS低氧严重程度方面具有临床价值。2、对于高危人群,可将ApEn作为诊断OSAHS的初筛。
[Abstract]:Background: 1, the most commonly used indicators to assess the severity of hypoxia during sleep in patients with obstructive sleep Apnea Hypopnea Syndrome (OSAHS) are minimum oxygen saturation (L02), oxygen Desaturation Index (ODI), and oxygen saturation (OSAHS). Less than 90% of the total recorded time (T 90%), etc. However, they can only reflect one aspect of hypoxia in patients, not the full picture of the severity of hypoxia. Polysomnography (PSG) is the gold standard for diagnosis of obstructive sleep apnea hypopnea syndrome (OSAS). But the operation is complicated, the cost is high, needs to carry on in the sleep laboratory, is not easy to popularize. Some foreign scholars think that nocturnal blood oxygen monitoring can replace PSG in primary screening of high-risk patients, but the selection of these parameters is still controversial. Objective: to study the significance of approximate entropy of blood oxygen saturation (ApEn) and Saturation injury time index (siti) in evaluating the severity of hypoxia during sleep and in diagnosing OSAHS in OSAHS patients, and to analyze the correlation with other parameters. To evaluate its clinical value. Methods: 500 suspected OSAHS patients were analyzed retrospectively. All subjects recorded anthropometric data for 6 hours of sleep apnea monitoring. According to AHI, the subjects were divided into 4 subgroups: normal control, mild, moderate and severe. The values of ApEn and siti were compared among the four groups. The correlation between AHI and AHI was analyzed. In addition, the correlation between ApEnSITi and ODILO2T90% was analyzed. According to AHI standard, the ROC curve analysis and Joden index were used to determine the significance of ApEnSITi in the diagnosis of OSAHS and the evaluation of hypoxic degree. SPSS 16.0 software was used for statistical analysis. Results among the 500 subjects, 361 (72.2%) were males and 139 (27.8%) females. The average age was 53.2 卤15.2 years (range 24-95 years). 1 ApEnSITi was significantly different among different groups (P0.001), and the value of ApEnSITi increased with the increase of AHI. Further comparison between the two groups showed that there was significant difference in ApEn among each group (P0.001), and there was significant difference in siti between other groups except the normal control group and the mild OSAHS group (P0.05). Spearman (?) Eye correlation analysis showed that ApEnSITi was positively correlated with AHI (r = 0.765 and R = 0.678, P 0.01). There was a good correlation between ApEnSITi and ODILO2T90%. According to the results of ROC curve analysis, Apen value of 16.70 ~ 17.81 ~ 20.03 can be used as the threshold value of mild, moderate and severe hypoxia in patients with OSAHS. The corresponding siti value is 3.6854.055V 4.445.2. According to PSG AHI 鈮，

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