目的: 探讨夜间指氧监测获得的氧减指数（oxygen desaturation index,ODI）与多导睡眠监测获得的呼吸暂停低通气指数（apnea-hypopnea index,AHI）及夜间血压间的关联性,观察ODI诊断阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAS）的灵敏度和特异度。方法: 选择2013年8月至2015年12月在上海交通大学医学院附属瑞金医院同时进行24 h动态血压监测及夜间指氧监测的患者中,其中ODI>3次/小时且合并24 h动态血压升高（≥130/80 mmHg）者,进行呼吸睡眠监测。采用Spearman相关性分析观察ODI与AHI间的关联,用受试者工作特征（receiver operator characteristic, ROC）曲线分析ODI诊断OSAS的灵敏度和特异度,协方差分析ODI与动态血压间的关系。结果: 184例受检者的平均年龄为51.3岁,其中52.7%为男性,50.5%正在接受降压治疗。结果: 提示ODI与AHI呈正相关（r=0.38,P<0.001）。以ODI≥8次/小时为临界值,诊断轻度以上OSAS（AHI≥5次/小时）的灵敏度为69.4%,特异度为65.0%,ROC曲线下面积为0.69;以ODI≥14次/小时为临界值,诊断中重度OSAS（AHI≥15次/小时）的灵敏度为48.3%,特异度为83.2%,ROC曲线下面积为0.68。随着观察对象的ODI升高,夜间收缩压、舒张压及心率均显著升高（趋势P<0.05）。与ODI指数<8次/小时组相比,ODI≥14次/小时组的夜间血压增高了6.2/4.7 mmHg,夜间心率增快了3.3次/分。结论: 简单无创的夜间指氧监测获取的ODI与睡眠监测获得的AHI相关,诊断OSAS的灵敏度和特异度尚可,且与夜间血压相关,有助于筛查夜间高血压的病因。
Objectives: To investigate the correlation of oxygen desaturation index (ODI) with apnea-hypopnea index (AHI) and nighttime blood pressure, and to calculate the sensitivity and specificity of ODI for diagnosing obstructive sleep apnea-hypopnea syndrome(OSAS). Methods: Standard polysomnography examination was conducted in patients who had 24-h ambulatory blood pressure and nighttime pulse oxygen saturation monitoring performed and having ODI>3 times/h and 24-h ambulatory hypertension (≥130/80 mmHg). The correlations of ODI with AHI and ambulatory blood pressure were analyzed by Spearman correlation analysis and covariance analysis; sensitivity and specificity of ODI for diagnosing OSAS were calculated by receiver operator characteristic(ROC) curve. Results: A total of 184 patients with average age of 51.3 years, 52.7% were male, and 50.5% were on antihypertensive treatment were enrolled. It showed that ODI was positively correlated with AHI (r=0.38, P<0.001). When ODI≥8 times/h was taken as cutoff value, the sensitivity and specificity for diagnosing moderate and severe OSAS (AHI≥5 times/h) were 69.4%, 65.0% respectively, and the area under the ROC curve was 0.69. When ODI≥14 times/h was taken as the cutoff value for diagnosing moderate and severe OSAS (AHI≥15 times/h), the corresponding values were 48.3%, 83.2% and 0.68, respectively. Nighttime systolic and diastolic blood pressures and heart rate increased with the increase of ODI (P for trends<0.05). Compared with those who had an ODI of <8 times/h, patients with ODI≥14 times/h suffered an increased nighttime blood pressure of 6.2/4.7 mmHg and a faster heart rate by 3.3 beats/min. Conclusions: ODI derived from a simple and noninvasive nighttime pulse oxygen saturation monitoring is correlated with the AHI obtained from polysomnography. The sensitivity and specificity of ODI for diagnosing OSAS is moderate and acceptable. ODI is correlated with nighttime blood pressure and should be helpful to the etiological analysis of nighttime hypertension.
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