本文選題：OSAS + 多導(dǎo)睡眠監(jiān)測(cè)儀��； 參考：《蘇州大學(xué)》2012年碩士論文

【摘要】：目的：探討GY-6620便攜式睡眠監(jiān)測(cè)儀在診斷阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)中的價(jià)值及睡眠呼吸監(jiān)測(cè)的HOLTER化的可行性。 方法：采用澳大利亞產(chǎn)COMPUMEDICES多導(dǎo)睡眠儀(PSG)和GY-6620便攜式睡眠監(jiān)測(cè)儀對(duì)100例懷疑有OSAHS的對(duì)象在睡眠中心進(jìn)行同步監(jiān)測(cè),隨后對(duì)其中的60人進(jìn)行GY-6620家庭監(jiān)測(cè)，采用線性相關(guān)、ROC曲線及Bland-Altman一致性分析方法對(duì)兩者進(jìn)行統(tǒng)計(jì)分析。 結(jié)果：1）同步分析研究：a）PSG與GY-6620一致性及相關(guān)性：Bland-Altman發(fā)現(xiàn)提示PSG與GY-6620測(cè)得睡眠呼吸暫停低通氣指數(shù)（AHI）、平均血氧、最低血氧、氧減3（ODI3）、氧減4（ODI4）在兩者間差的平均值分別為2、0.9、0.9、0.2、3、7一致性良好，兩者顯著相關(guān)（AHI：R=0.99，平均血氧：R=0.78，最低血氧R=0.91，ODI3：R=0.95，ODI4:R=0.92，P均小于0.01）；b）GY-6620診斷OSAS的價(jià)值：ROC曲線下面積為0.95，(CI:0.92--0.99），以AHI5為診斷OSAS的截點(diǎn)，其敏感性為82%，特異性為100%，陽(yáng)性預(yù)測(cè)值為100%，陰性預(yù)測(cè)值為70.7%；2）GY-6620便攜式睡眠監(jiān)測(cè)儀家庭監(jiān)測(cè)與睡眠中心PSG監(jiān)測(cè)對(duì)比研究：a) GY-6620數(shù)據(jù)的完整性為95%；b）PSG與GY-6620一致性及相關(guān)性：兩者間AHI的差的平均值為4.2，上下界分別為14.6、6,95%患者都在此范圍內(nèi)，兩者一致性高，并且具有顯著相關(guān)性(R=0.97,P0.01)；c）診斷OSAS的價(jià)值：診斷輕度OSAS的價(jià)值，ROC曲線分析發(fā)現(xiàn)AUC為0.98，其敏感性為89.36%，特異性及陽(yáng)性預(yù)測(cè)值為100%，陰性預(yù)測(cè)值66.7%，診斷重度OSAS，其AUC為0.98，敏感性為76.19%，特異性為94.4%，陽(yáng)性預(yù)測(cè)值為88.9%，陰性預(yù)測(cè)值87.2%，以AHI為15為診斷標(biāo)準(zhǔn)其診斷價(jià)值最高，曲線下面積為0.99，它的敏感性高達(dá)91%，特異性及陽(yáng)性預(yù)測(cè)值為100%，陰性預(yù)測(cè)值為87.5%。結(jié)論：GY-6620便攜式睡眠監(jiān)測(cè)儀具有臨床診斷OSAS的價(jià)值，睡眠呼吸監(jiān)測(cè)HOLTER化是可行的。 目的：探討冠心病、脈搏波傳導(dǎo)速度（PWV）及睡眠呼吸暫停綜合征（OSAS）的三者間的關(guān)系以及可能的機(jī)制。 方法：對(duì)2012年01月至2012年3月期間以冠心病或胸痛原因待查收入我中心的135例患者，進(jìn)行冠狀動(dòng)脈造影、睡眠呼吸監(jiān)測(cè)及PWV測(cè)定，抽血化驗(yàn)血脂、血糖c-反應(yīng)蛋白等，對(duì)其結(jié)果進(jìn)行分析。 結(jié)果：（1）冠狀動(dòng)脈造影確診冠心病75例，其中單支病變15例，雙支病變19例，多支病變41例，中重度睡眠呼吸暫停綜合征患者63例；(2)中重度OSAS組的冠心病發(fā)病率、Gensini評(píng)分明顯高于非中重度OSAS組（Gensini評(píng)分：13.53±16.91VS28.98±23.87P均0.05）；在1支病變、2病變及多支病變3組中，中重度OSAS發(fā)病率存在統(tǒng)計(jì)學(xué)差異，中重度OSAS發(fā)病率與病變支數(shù)成正相關(guān)（R=0.376,p0.01）;（3）中重度OSAS組的PWV明顯高于非中重度OSAS組（PWV：1349.97±222.58VS1615.52±190.19），PWV與AHI成正相關(guān)（R=0.40,P0.01）；（4）PWV在冠心病組與非冠心病組存在統(tǒng)計(jì)學(xué)差異(PWV：1621.24±190.31vs1393.05±131.50，P=0.00)，PWV在1支病變、2病變及多支病變3組中存在統(tǒng)計(jì)學(xué)差異（PWV:1476.2±163.52VS1545.63±174.3，1545.63±174.3VS1680.10±215.72,1476.2±163.52VS1680.10±215.72），與病變支數(shù)成正相關(guān)（R=0.368,P0.01），與Gensini評(píng)分成正相關(guān)（R=0.60，P0.01）; 結(jié)論：OSAS是冠心病的危險(xiǎn)因素，OSAS組PWV顯著高于非OSAS組，PWV是體現(xiàn)動(dòng)脈硬化的指標(biāo)，，動(dòng)脈硬化可能是OSAS引起冠心病的一種機(jī)制。
[Abstract]:Objective : To investigate the value of GY - 6620 portable sleep monitor and the feasibility of HOLTER in diagnosis of obstructive sleep apnea and hypoventilation syndrome .

Methods : Using PSG and GY - 6620 portable sleep monitor to monitor 100 cases of suspected obstructive sleep apnea , 60 of them were monitored by GY - 6620 family . Linear correlation , ROC curve and Bland - Altman consistency analysis method were used to analyze the two .

Results : 1 ) Synchronous analysis : a ) PSG and GY - 6620 consistency and correlation : Bland - Altman showed that PSG and GY - 6620 showed that PSG and GY - 6620 measured sleep apnea - low - permeability index ( ahi ) , mean blood oxygen , lowest blood oxygen , oxygen decreased 3 ( ODI3 ) , oxygen decreased 4 ( ODI4 ) were significantly correlated with the average blood oxygen : R = 0.78 , lowest blood oxygen R = 0.91 , ODI3 : R = 0.95 , ODI4 : R = 0.92 , P < 0.01 ) ;
( b ) The value of the diagnosis of obstructive sleep apnea syndrome by GY - 6620 : the area under ROC curve is 0.95 , ( CI : 0.92 - 0.99 ) , the sensitivity of AHI5 is 82 % , the specificity is 100 % , the positive predictive value is 100 % , and the negative predictive value is 70.7 % ;
2 ) Comparison of Family Monitoring and Sleep Center PSG Monitoring in GY - 6620 Portable Sleep Monitor : a ) The completeness of GY - 6620 data is 95 % ;
b ) The consistency and correlation between PSG and GY - 6620 : the mean value of the difference between the two indexes was 4.2 , the upper and lower bounds were 14.6 , 6 and 95 % respectively , the consistency was high , and the correlation was significant ( R = 0.97 , P0.01 ) ;
c ) The diagnostic value of obstructive sleep apnea syndrome was diagnosed by ROC curve . The sensitivity was 89.36 % , the specificity and positive predictive value were 100 % , the negative predictive value was 76.2 % , the positive predictive value was 88 . 9 % , the negative predictive value was 87.2 % , the positive predictive value was 100 % , the negative predictive value was 87.5 % . Conclusion : GY - 6620 Portable sleep monitor has the value of clinical diagnosis and HOLTER is feasible .

Objective : To investigate the relationship among coronary heart disease ( CHD ) , pulse wave conduction velocity ( PWV ) and sleep apnea syndrome ( sleep apnea syndrome ) and possible mechanism .

Methods : From January 2012 to March 2012 , 135 patients with coronary heart disease or chest pain were analyzed by coronary angiography , sleep apnea monitoring and PWV determination , blood sampling test , blood lipid and blood sugar c - reactive protein .

Results : ( 1 ) There were 75 cases of coronary heart disease diagnosed by coronary angiography , including 15 cases of single branch , 19 cases of bilateral lesion , 41 cases with multiple lesions and 63 cases of moderate and severe sleep apnea syndrome ;
( 2 ) The incidence of coronary heart disease and Gensini score were significantly higher in patients with moderate and severe obstructive sleep apnea syndrome ( Gensini score : 13.53 鹵 16.91V288.98 鹵 23.87P 0.05 ) .
There was a statistical difference in the incidence of moderate and severe obstructive sleep apnea syndrome in 3 groups of 1 lesion , 2 lesion and multiple lesions ( R = 0.376 , p0.01 ) , and ( 3 ) PWV in patients with moderate to severe obstructive sleep apnea syndrome ( PWV : 1349.97 鹵 222.58VS165.52 鹵 190.19 ) , PWV positively correlated with ahi ( R = 0.40 , P0.01 ) .
( 4 ) There was statistical difference in PWV between coronary heart disease group and non - coronary heart disease group ( PWV : 21.24 鹵 190.31vs 1393.05 鹵 131.50 , P = 0.00 ) , PWV had statistical difference in 1 lesion , 2 lesion and 3 groups of multiple lesions ( PWV : 1476.2 鹵 163.52VS1545.63 鹵 174.3 , 1545.63 鹵 174.3VS168.72 , 1476.2 鹵 167.52VS168.10 鹵 215.72 ) , which was positively correlated with Gensini score ( R = 0.60 , P0.01 ) ;

Conclusion : As a risk factor for coronary heart disease , PWV is significantly higher than that in non - obstructive sleep group , PWV is an indicator of arteriosclerosis , and arteriosclerosis may be a mechanism to cause coronary heart disease .
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R766

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