[Cardiopulmonary coupling analysis in diagnosis of sleep disorders].

Objectives: To compare diagnostic consistency for chronic insomnia (CI) and obstructive sleep apnea (OSA) between cardiopulmonary coupling (CPC) and polysomnographm (PSG). Methods: Two hundred and twenty-one patients were enrolled from the Department of Sleep Disorders, Chaohu Hospital affiliated to Anhui Medical University from July 2018 to December 2019, and monitored with overnight CPC and PSG simultaneously. According to clinical representations and PSG results, there were 88 males and 80 females with CI and OSA, including chronic insomnia (CI group, 93 cases), OSA (OSA group, 36 cases) and comorbid OSA with CI (COI group, 39 cases). The consistency of sleep and OSA parameters measured with CPC and PSG were analyzed. Results: (1)For all patients and CI group, the total sleep time (TST), sleep efficiency (SE) and rapid eye movement (REM) sleep time measured by CPC were significantly higher than those measured with PSG, and the wake time after sleep onset (WASO) was significantly lower than that measured with PSG (the specific median comparisons were as follows 420.0 min vs 395.5 min, 93.7% vs 81.8%, 90.0 min vs 37.5 min, 18.0 min vs 63.0 min in CI group, respectively; 414.0 min vs 392.5 min, 91.9% vs 81.9%, 72.0 min vs 34.8 min, 24.0 min vs 58.4 min in all patients, respectively (all P≤0.001). However, in the OSA patients, the TST, SE, WASO, REM sleep time and NREM sleep time measured using two methods were similar (all P>0.05). (2) According to OSA criteria, the consistency between CPC and PSG was fair (κ=0.255). Only CPC has a certain degree of value for OSA screening when the AHI ≥ 20/h (κ=0.580, sensitivity: 0.85, specificity: 0.82, positive predictive value: 0.59, negative predictive value: 0.95, positive likelihood ratio: 4.72). Conclusion: CPC technology may overestimate the sleep quality of CI patients, and its consistency is fair compared with that of PSG in the diagnosis of OSA.目的： 探讨心肺耦合（CPC）分析技术在慢性失眠（CI）和阻塞性睡眠呼吸暂停（OSA）中的诊断价值。 方法： 连续收集2018年7月至2019年12月于安徽医科大学附属巢湖医院睡眠障碍科就诊患者221例，夜间同步行多导睡眠图（PSG）和CPC监测。根据临床症状和PSG结果，CI及OSA患者168例（男88例，女80例），其中单纯CI（CI组）93例，单纯OSA（OSA组）36例，CI和OSA共病（COI组）39例。分析CPC和PSG测定的各项睡眠指标的一致性和两者对OSA诊断的一致性。 结果： （1）在CI组或所有患者，CPC测定的TST、SE和REM睡眠时间显著高于PSG测定值，WASO显著低于PSG测定值（具体中位数对比是：CI组420.0 min比395.5 min、93.7%比81.8%、90.0 min比37.5 min、18.0 min比63.0 min；所有患者414.0 min比392.5 min、91.9%比81.9%、72.0 min比34.8 min、24.0 min比58.4 min；均P≤0.001）；但在OSA组，CPC与PSG测定的TST、SE、WASO、REM睡眠时间和NREM睡眠时间无显著差异（均P>0.05）。（2）按OSA标准，CPC与PSG诊断的一致性不佳（κ=0.255）。仅当AHI≥ 20次/h时CPC对OSA筛查有一定价值（κ=0.580，敏感度0.85，特异度0.82，阳性预测值0.59，阴性预测值0.95，阳性似然比4.72）。 结论： CPC存在高估CI患者睡眠质量的可能，其与PSG诊断OSA的性能相比，一致性欠佳。.