Introduction

Automatic event detection (AED) of residual apnea-hypopnea index (AHI) by ventilators is a current practice in sleep and mechanical ventilation Units but this methodology has not been validated in an unselected population of OSA patients. Aim of the present study was to assess in a “real-life” condition the reliability of AED during PAP therapy by the in-built software compared to full polysomnography during follow-up.

Methods

We enrolled 300 OSA patients (105 F; AHI 45.3 ± 27.8) already on Positive airway pressure (PAP) therapy: 53% of the patients were on CPAP while other modalities were used in the rest of the sample.

Results

Overall, the built-in software identified residual obstructive AHI (AHI_PAP) > 5, 10 or 15 in 18.7, 8.6 or 4.6% of patients, respectively. By using AHI_PAP, 28.4% of patients were wrongly classified as “well controlled” despite a residual AHI_PSG>5 (6% considering a residual AHI_VENT >15); 7% of patients were classified as not controlled while AHI_PSG was <5 (1.4% considering a residual AHI_VENT >15). Type of ventilation, ventilator parameters, adherence to treatment and level of baseline or follow-up Epworth Sleepiness Scale score were similar between groups. The sensitivity and positive predicted values were very low. Positive likelihood ratio appears adequate only for residual AHI_PAP ≥10, but negative likelihood ratio was inconclusive for all the cut-off considered.

Discussion

The results of the present study suggest a more cautious approach in the follow-up of OSA patients, since a protocol based only on AED detection and symptoms assessment may not be accurate especially for AHI_PAP<15.

中文翻译：

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阻塞性睡眠呼吸暂停患者气道正压治疗期间自动检测 AHI 的可靠性：一项“现实生活研究”

介绍

通过呼吸机对残余呼吸暂停低通气指数 (AHI) 进行自动事件检测 (AED) 是睡眠和机械通气病房的当前做法，但这种方法尚未在未经选择的 OSA 患者群体中得到验证。本研究的目的是在“现实生活”条件下评估内置软件 PAP 治疗期间 AED 与随访期间完整多导睡眠图相比的可靠性。

方法

我们招募了 300 名已经接受气道正压通气 (PAP) 治疗的 OSA 患者（105 F；AHI 45.3 ± 27.8）：53% 的患者接受 CPAP，而其余样本则使用其他治疗方式。

结果

总体而言，内置软件分别在 18.7%、8.6% 或 4.6% 的患者中识别出残余阻塞性 AHI (AHI _PAP ) > 5、10 或 15。通过使用 AHI _PAP，尽管残余 AHI _PSG >5，仍有 28.4% 的患者被错误地归类为“控制良好”（6% 考虑到残余 AHI _VENT >15）；_{当 AHI PSG} <5时，7% 的患者被分类为未受控制（1.4% 考虑到残余 AHI _VENT >15）。各组之间的通气类型、呼吸机参数、治疗依从性以及基线或随访 Epworth 嗜睡量表评分水平相似。敏感性和阳性预测值非常低。_{仅当残余 AHI PAP} ≥10 时，阳性似然比似乎足够，但对于所有考虑的截止值，阴性似然比都没有结论。

讨论

本研究的结果表明，在 OSA 患者的随访中应采取更加谨慎的方法，因为仅基于 AED 检测和症状评估的方案可能不准确，尤其是对于 AHI PAP <15 的_情况。