The utility of perioperative polygraphy in the diagnosis of obstructive sleep apnea
Jazyk angličtina Země Nizozemsko Médium print-electronic
Typ dokumentu srovnávací studie, časopisecké články, práce podpořená grantem
PubMed
27823709
DOI
10.1016/j.sleep.2016.03.009
PII: S1389-9457(16)30005-3
Knihovny.cz E-zdroje
- Klíčová slova
- Obstructive sleep apnea, Screening, Sedation, Sleep-disordered breathing,
- MeSH
- ambulantní monitorování přístrojové vybavení MeSH
- epidurální anestezie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- obstrukční spánková apnoe diagnóza epidemiologie patofyziologie MeSH
- perioperační období MeSH
- plošný screening přístrojové vybavení MeSH
- polysomnografie metody MeSH
- prevalence MeSH
- propofol aplikace a dávkování MeSH
- senioři MeSH
- spánek fyziologie MeSH
- spánková apnoe centrální diagnóza epidemiologie MeSH
- totální endoprotéza kolene metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Názvy látek
- propofol MeSH
OBJECTIVE/BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent and often undiagnosed in surgical patients. The aim of this study was to compare polygraphy (PG) performed on sedated patients during surgery to overnight polysomnography (PSG). It was hypothesized that perioperative PG may be used to diagnose OSA. PATIENTS/METHODS: Overnight PSG was performed three days prior to surgery. For surgery, spinal anesthesia and sedation with propofol infusion were used. Sedation depth was monitored by the Bispectral index and maintained for all patients (target level 75). Echocardiography studies were available in three patients, and all were diagnosed with diastolic dysfunction. Relatively high prevalence of CSA in patients with diastolic dysfunction has been previously reported. During surgery, PG recording (Embletta) was performed. Sleep apnea was defined by the type (central/obstructive apnea ≥50%) and by the apnea-hypopnea index (AHI) (events/hour: AHI < 5 no apnea; 5 ≤ AHI < 15 mild apnea; 15 ≤ AHI < 30 moderate apnea; AHI ≥30 severe apnea). Bland-Altman plots were used for analysis, and 2 × 2 decision statistics were calculated for several cut-off values of the AHI. Data were shown as bias with limits of agreement (bias±1.96 standard deviations). RESULTS: Nineteen subjects were studied: nine (47%) were diagnosed with obstructive, seven (37%) with central sleep apnea, and three (16%) with no sleep apnea by overnight PSG. Perioperative PG bias was 12 (-37; 61) for AHI; 6 (-25; 37) for obstructive apnea; 0 (-4; 4) for central apnea, and 6 (-31; 43) for hypopnea. For the detection of OSA, a PG cut-off value of AHI 5 yielded 89% sensitivity and 60% specificity, AHI 15 yielded 86% sensitivity and 67% specificity, and AHI 30 yielded 100% sensitivity and 71% specificity. CONCLUSION: Wide limits of agreement preclude perioperative PG to be used as a diagnostic method; however, it may be useful to screen sedated surgical patients for OSA.