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发布时间：2018-06-19 00:28

本文选题：OSAS + 多导睡眠监测仪　；参考：《苏州大学》2012年硕士论文

【摘要】：目的：探讨GY-6620便携式睡眠监测仪在诊断阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中的价值及睡眠呼吸监测的HOLTER化的可行性。方法：采用澳大利亚产COMPUMEDICES多导睡眠仪(PSG)和GY-6620便携式睡眠监测仪对100例怀疑有OSAHS的对象在睡眠中心进行同步监测,随后对其中的60人进行GY-6620家庭监测，采用线性相关、ROC曲线及Bland-Altman一致性分析方法对两者进行统计分析。结果：1）同步分析研究：a）PSG与GY-6620一致性及相关性：Bland-Altman发现提示PSG与GY-6620测得睡眠呼吸暂停低通气指数（AHI）、平均血氧、最低血氧、氧减3（ODI3）、氧减4（ODI4）在两者间差的平均值分别为2、0.9、0.9、0.2、3、7一致性良好，两者显著相关（AHI：R=0.99，平均血氧：R=0.78，最低血氧R=0.91，ODI3：R=0.95，ODI4:R=0.92，P均小于0.01）；b）GY-6620诊断OSAS的价值：ROC曲线下面积为0.95，(CI:0.92--0.99），以AHI5为诊断OSAS的截点，其敏感性为82%，特异性为100%，阳性预测值为100%，阴性预测值为70.7%；2）GY-6620便携式睡眠监测仪家庭监测与睡眠中心PSG监测对比研究：a) GY-6620数据的完整性为95%；b）PSG与GY-6620一致性及相关性：两者间AHI的差的平均值为4.2，上下界分别为14.6、6,95%患者都在此范围内，两者一致性高，并且具有显著相关性(R=0.97,P0.01)；c）诊断OSAS的价值：诊断轻度OSAS的价值，ROC曲线分析发现AUC为0.98，其敏感性为89.36%，特异性及阳性预测值为100%，，阴性预测值66.7%，诊断重度OSAS，其AUC为0.98，敏感性为76.19%，特异性为94.4%，阳性预测值为88.9%，阴性预测值87.2%，以AHI为15为诊断标准其诊断价值最高，曲线下面积为0.99，它的敏感性高达91%，特异性及阳性预测值为100%，阴性预测值为87.5%。结论：GY-6620便携式睡眠监测仪具有临床诊断OSAS的价值，睡眠呼吸监测HOLTER化是可行的。目的：探讨冠心病、脉搏波传导速度（PWV）及睡眠呼吸暂停综合征（OSAS）的三者间的关系以及可能的机制。方法：对2012年01月至2012年3月期间以冠心病或胸痛原因待查收入我中心的135例患者，进行冠状动脉造影、睡眠呼吸监测及PWV测定，抽血化验血脂、血糖c-反应蛋白等，对其结果进行分析。结果：（1）冠状动脉造影确诊冠心病75例，其中单支病变15例，双支病变19例，多支病变41例，中重度睡眠呼吸暂停综合征患者63例；(2)中重度OSAS组的冠心病发病率、Gensini评分明显高于非中重度OSAS组（Gensini评分：13.53±16.91VS28.98±23.87P均0.05）；在1支病变、2病变及多支病变3组中，中重度OSAS发病率存在统计学差异，中重度OSAS发病率与病变支数成正相关（R=0.376,p0.01）;（3）中重度OSAS组的PWV明显高于非中重度OSAS组（PWV：1349.97±222.58VS1615.52±190.19），PWV与AHI成正相关（R=0.40,P0.01）；（4）PWV在冠心病组与非冠心病组存在统计学差异(PWV：1621.24±190.31vs1393.05±131.50，P=0.00)，PWV在1支病变、2病变及多支病变3组中存在统计学差异（PWV:1476.2±163.52VS1545.63±174.3，1545.63±174.3VS1680.10±215.72,1476.2±163.52VS1680.10±215.72），与病变支数成正相关（R=0.368,P0.01），与Gensini评分成正相关（R=0.60，P0.01）; 结论：OSAS是冠心病的危险因素，OSAS组PWV显著高于非OSAS组，PWV是体现动脉硬化的指标，动脉硬化可能是OSAS引起冠心病的一种机制。
[Abstract]:Objective : To investigate the value of GY - 6620 portable sleep monitor and the feasibility of HOLTER in diagnosis of obstructive sleep apnea and hypoventilation syndrome .

Methods : Using PSG and GY - 6620 portable sleep monitor to monitor 100 cases of suspected obstructive sleep apnea , 60 of them were monitored by GY - 6620 family . Linear correlation , ROC curve and Bland - Altman consistency analysis method were used to analyze the two .

Results : 1 ) Synchronous analysis : a ) PSG and GY - 6620 consistency and correlation : Bland - Altman showed that PSG and GY - 6620 showed that PSG and GY - 6620 measured sleep apnea - low - permeability index ( ahi ) , mean blood oxygen , lowest blood oxygen , oxygen decreased 3 ( ODI3 ) , oxygen decreased 4 ( ODI4 ) were significantly correlated with the average blood oxygen : R = 0.78 , lowest blood oxygen R = 0.91 , ODI3 : R = 0.95 , ODI4 : R = 0.92 , P < 0.01 ) ;
( b ) The value of the diagnosis of obstructive sleep apnea syndrome by GY - 6620 : the area under ROC curve is 0.95 , ( CI : 0.92 - 0.99 ) , the sensitivity of AHI5 is 82 % , the specificity is 100 % , the positive predictive value is 100 % , and the negative predictive value is 70.7 % ;
2 ) Comparison of Family Monitoring and Sleep Center PSG Monitoring in GY - 6620 Portable Sleep Monitor : a ) The completeness of GY - 6620 data is 95 % ;
b ) The consistency and correlation between PSG and GY - 6620 : the mean value of the difference between the two indexes was 4.2 , the upper and lower bounds were 14.6 , 6 and 95 % respectively , the consistency was high , and the correlation was significant ( R = 0.97 , P0.01 ) ;
c ) The diagnostic value of obstructive sleep apnea syndrome was diagnosed by ROC curve . The sensitivity was 89.36 % , the specificity and positive predictive value were 100 % , the negative predictive value was 76.2 % , the positive predictive value was 88 . 9 % , the negative predictive value was 87.2 % , the positive predictive value was 100 % , the negative predictive value was 87.5 % . Conclusion : GY - 6620 Portable sleep monitor has the value of clinical diagnosis and HOLTER is feasible .

Objective : To investigate the relationship among coronary heart disease ( CHD ) , pulse wave conduction velocity ( PWV ) and sleep apnea syndrome ( sleep apnea syndrome ) and possible mechanism .

Methods : From January 2012 to March 2012 , 135 patients with coronary heart disease or chest pain were analyzed by coronary angiography , sleep apnea monitoring and PWV determination , blood sampling test , blood lipid and blood sugar c - reactive protein .

Results : ( 1 ) There were 75 cases of coronary heart disease diagnosed by coronary angiography , including 15 cases of single branch , 19 cases of bilateral lesion , 41 cases with multiple lesions and 63 cases of moderate and severe sleep apnea syndrome ;
( 2 ) The incidence of coronary heart disease and Gensini score were significantly higher in patients with moderate and severe obstructive sleep apnea syndrome ( Gensini score : 13.53 卤 16.91V288.98 卤 23.87P 0.05 ) .
There was a statistical difference in the incidence of moderate and severe obstructive sleep apnea syndrome in 3 groups of 1 lesion , 2 lesion and multiple lesions ( R = 0.376 , p0.01 ) , and ( 3 ) PWV in patients with moderate to severe obstructive sleep apnea syndrome ( PWV : 1349.97 卤 222.58VS165.52 卤 190.19 ) , PWV positively correlated with ahi ( R = 0.40 , P0.01 ) .
( 4 ) There was statistical difference in PWV between coronary heart disease group and non - coronary heart disease group ( PWV : 21.24 卤 190.31vs 1393.05 卤 131.50 , P = 0.00 ) , PWV had statistical difference in 1 lesion , 2 lesion and 3 groups of multiple lesions ( PWV : 1476.2 卤 163.52VS1545.63 卤 174.3 , 1545.63 卤 174.3VS168.72 , 1476.2 卤 167.52VS168.10 卤 215.72 ) , which was positively correlated with Gensini score ( R = 0.60 , P0.01 ) ;

Conclusion : As a risk factor for coronary heart disease , PWV is significantly higher than that in non - obstructive sleep group , PWV is an indicator of arteriosclerosis , and arteriosclerosis may be a mechanism to cause coronary heart disease .
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R766

【参考文献】