微动敏感床垫式睡眠监测仪在OSAHS诊断中的应用

发布时间：2018-05-02 23:05

本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 多导睡眠监测　；参考：《吉林大学》2011年硕士论文

【摘要】：目的：分析床垫式睡眠监测系统(MSMS)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)诊断中的意义。方法：2010年6月至2010年12月就诊于吉林大学中日联谊医院耳鼻咽喉头颈外科的疑似OSAHS患者73例,采集临床资料(年龄、性别、身高、体重、颈围及Epworth嗜睡量表评分)分别经过PSG和MSMS两种监测系统监测睡眠,获得睡眠监测结果(PSG方法组和MSMS方法组)。根据2009年美国(AASM) OSAHS诊断指南中阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)诊断标准,以PSG作为金标准,分析MSMS方法诊断OSAHS的敏感性和特异性以及组间差异。分析MSMS监测系统中AHI指数与临床参数(年龄、性别、体重指数、颈围等)的相关性。结果：1分析性别、年龄与OSAHS患者发病的相关性。73例疑似OSAHS患者其中男59例,女14例,性别比为4.2：1,年龄20-77岁,平均(46.22±9.99)岁。PSG检测结果为AHI为1.20～95.80次/h,平均为(39.798±25.77)次/h。按性别(男、女)、年龄(18～39组,40～59组,60组)分组比较患者的AHI严重程度(正常、轻度、中度、重度),发现各组间AHI有显著性差异(P0.05),其中以中青年男性发病率最高,病情最重。 2应用相关性方程Pearson分析NC、BMI与AHI之间的相关性。73例受检者的颈围(NC)为(30～48)cm,平均(40.715±4.421)cm,体重指数(BMI)为17.1～39kg/m2,平均(28.292±4.353)kg/m2。AHI为(1.20～95.80)次/h,平均为(39.798±25.77)次/h。①BMI与AHI相关性比较,认为两者之间存在正相关关系(P0.05)。②同样方法将NC与AHI两者进行双变量相关性比较,认为NC与AHI两者之间存在正相关关系(P0.05),且NC与AHI之间相关性更大。 3 OSAHS患者Epworth嗜睡量表(ESS)的评分(EP)与AHI轻重程度之间进行相关性分析：采用非参数多样本秩和检验(Kruskal-Wallis法,即H检验)分析比较ESS嗜睡程度(正常、轻度嗜睡、中度嗜睡、重度嗜睡)与AHI的严重程度(正常、轻度、中度、重度)。发现重度OSAHS组稍高于正常以及轻、中度OSAHS组的ESS中位数值,分析发现重度OSAHS组与其他各组间差异有统计学意义。 4 PSG与MSMS检测结果比较：本实验中73例受检者经PSG监测的AHI为1.20～95.80次/h,平均为(39.798±25.77)次/h。隔夜行MSMS监测的AHI为2.00～105.10次/h,平均为(42.193±26.92)次/h。以AHI5为阳性诊断指标：PSG方法检验阳性68例,MSMS方法检验阳性70例,两者同为阴性3例,两者同为阳性68例。以PSG阳性为金标准,MSMS方法的灵敏度为100%,特异度为90%,采用配对χ2检验的方法比较两种方法,发现两种方法诊断OSAHS无统计学意义(P0.05)。根据AHI值将受检者进行分组：PSG组(正常5例,轻度14例,中度13例,重度41例)、MSMS组(正常3例,轻度13例,中度15例,重度42例),应用行×列表资料的χ2检验方法比较两种检测方法的构成比差异无统计学意义(P0.05)。结论：1.本实验结果显示床垫系统判断OSAHS患者的AHI的灵敏度为100.0%,特异度为90%。微动敏感床垫对阻塞性呼吸事件的敏感度高于PSG结果床垫系统是用于睡眠呼吸疾病的筛查和临床诊断的重要方法。 2.本研究结果显示ESS评分可以从一个侧面显示病情程度的变化,它联合睡眠床垫,为OSAHS诊断提供较客观的临床依据,也为患者提供一个简便、易行的自评工具。 3.体重指数(BMI)、颈围(NC)都是衡量肥胖的参数。颈围更能直接反应颈部脂肪的情况,是目前反映睡眠时上气道口径及功能最特异的指标,颈围增粗的睡眠打鼾者可视为OSAHS的高危人群。
[Abstract]:Objective: to analyze the significance of mattress sleep monitoring system (MSMS) in the diagnosis of obstructive sleep apnea hypopnea syndrome (OSAHS).
Methods: from June 2010 to December 2010, 73 suspected OSAHS patients were diagnosed at the otorhinolaryngology head and neck surgery of the Sino Japanese Friendship Hospital of Jilin University. The clinical data (age, sex, height, weight, neck circumference and Epworth sleepiness scale score) were monitored by two monitoring systems of PSG and MSMS, and the results of sleep monitoring were obtained (PSG method group and MSMS method group. Based on the diagnostic criteria of obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome, OSAHS) in the 2009 American (AASM) OSAHS diagnostic guide and PSG as a gold standard, the sensitivity and specificity of MSMS method in the diagnosis of OSAHS and the difference between groups were analyzed. Correlation between clinical parameters (age, sex, body mass index, neck circumference, etc.).
Results: 1 the correlation between sex, age and the incidence of OSAHS patients was.73 cases of suspected OSAHS patients, including 59 males and 14 females, sex ratio was 4.2:1, age 20-77 years, and the average (46.22 + 9.99) years old.PSG test results were 1.20 to 95.80 /h, the average was (39.798 + 25.77) / h. by sex (male, female), age (18~39, 40~59, 60) groups. The severity of AHI (normal, mild, moderate, severe) was compared to the patients. There was a significant difference in AHI (P0.05) among the groups. Among them, the incidence of the middle and young men was the highest and the disease was the most serious.
2 the correlation equation Pearson analysis NC, the correlation between BMI and AHI, the neck circumference (NC) of the examiner was (30~48) cm, the average (40.715 + 4.421) cm, and the body mass index (BMI) was 17.1 ~ 39kg/m2, the average (28.292 + 4.353) kg/m2.AHI was (1.20 to 95.80) /h, and the average was (39.798 + 25.77). In the positive correlation (P0.05). (2) the same method compares the bivariate correlation between NC and AHI. It is considered that there is a positive correlation between NC and AHI (P0.05), and the correlation between NC and AHI is greater.
The correlation analysis between 3 OSAHS patients' Epworth sleepiness scale (ESS) score (EP) and the severity of AHI: an analysis of the severity of ESS somnolence (normal, mild sleepiness, moderate sleepiness, severe sleepiness) and AHI (normal, mild, moderate, severe) by non parametric multisample rank sum test (Kruskal-Wallis, or H test). The median ESS values in group OSAHS were slightly higher than those in normal, mild and moderate OSAHS groups, and the difference between severe OSAHS group and other groups was statistically significant.
4 PSG and MSMS test results: in this experiment, 73 cases of PSG monitored by AHI were 1.20 to 95.80 times /h, and the average (39.798 + 25.77) /h. septum MSMS monitoring was 2 to 105.10 times /h, and the average was (42.193 + 26.92) /h. with AHI5 as positive diagnostic index: PSG square test was positive and positive 70 cases were tested. Both The same was negative in 3 cases, both were positive in 68 cases, with PSG positive as gold standard, the sensitivity of MSMS method was 100%, the specificity was 90%, two methods were compared by paired chi 2 test, and two methods were found to have no statistical significance (P0.05). According to the AHI value, the subjects were grouped in PSG group (normal 5 cases, mild 14 cases, and moderate 13 cases,) Severe 41 cases), group MSMS (normal 3 cases, mild 13 cases, moderate 15 cases, 42 severe cases), the x 2 test method of using X list data was used to compare the composition of two detection methods with no statistically significant difference (P0.05).
Conclusion: 1. the results of the 1. experiments show that the sensitivity of the mattress system to determine the AHI of the OSAHS patients is 100%. The sensitivity of the specificity of the mattress is higher than that of the 90%. microdynamic mattress. The sensitivity of the mattress is higher than the PSG result mattress system is an important method for the screening and clinical diagnosis of sleep respiratory diseases.
2. the results of the study show that the ESS score can show the changes in the degree of the disease from one side. It combined with sleep mattress, provides a more objective clinical basis for the diagnosis of OSAHS, and provides a simple and easy self-assessment tool for the patients.
The 3. body mass index (BMI) and neck circumference (NC) are all parameters for measuring obesity. The neck circumference can reflect the neck fat more directly. It is the most specific indicator of the upper airway diameter and function at present, and the roughened snorers in the neck circumference can be regarded as the high-risk group of OSAHS.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766.4

【参考文献】