The Chinese Medical Journal points out: Type IV sleep monitoring can be used for clinical screening of OSA!
The Chinese Medical Journal points out: Type IV sleep monitoring can be used for clinical screening of OSA!
Obstructive sleep apnea (OSA) is a common sleep breathing disease, with apnea-hypopnea index (AHI) ≥ 5 times / h as the diagnostic criteria, there are about 176 million patients in China, and the number of patients ranks first in the world. Given the enormous medical burden of the disease, it is of great significance to screen, diagnose and manage high-risk groups based on the risk factors for OSA.
At present, the prevention and treatment of OSA is still mainly based on tertiary first-class general hospitals that have carried out sleep breath diagnosis and treatment. Due to the limitations of the number of hospitals and the strength of technical personnel who carry out the diagnosis and treatment of sleep respiratory diseases, the number of OSA patients who actually receive diagnosis and treatment is very limited, and the population's awareness of OSA is low, and it is impossible to prevent or actively diagnose and treat, most of the high-risk patients with OSA cannot be identified, and the management difficulty is significantly increased after the course of the disease progresses to comorbidities.
Relying solely on a single way for patients to go to the hospital to implement OSA diagnosis and treatment is far from meeting the actual needs, and early screening is needed to move the OSA prevention and treatment threshold forward. In order to further improve the awareness rate and diagnosis and treatment coverage of OSA, the Sleep Respiratory Disorders Group of the Respiratory Branch of the Chinese Medical Association and the Sleep Respiratory Equipment Group of the Respiratory Equipment Technology Professional Committee of the Chinese Medical Equipment Association organized relevant experts to conduct a comprehensive review of the relevant research on the screening and management of adult OSA at home and abroad, fully discussed, and jointly formulated this consensus, and made standardized suggestions for the screening objects, screening methods and management methods of high-risk groups of OSA. It aims to provide practical evidence-based guidance for the screening and management of high-risk groups of OSA in China, with a view to slowing down the progression of OSA disease, reducing comorbidities, improving the quality of life and quality of life, reducing OSA-related traffic accidents, target organ damage and medical costs, and laying the foundation for the realization of the 2030 National Health Action Plan.
Screening tools and methods for OSA
Sleep monitoring tools
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PSG: PSG is the gold standard for diagnosing OSA, but it is time-consuming, expensive, technically demanding, and long waiting time for examination. Screening of high-risk groups of OSA is more suitable for simple, convenient, fast and low-cost screening methods. PSG is mostly used to confirm the diagnosis after OSA screening. For high-risk groups screened for OSA, PSG is preferred for diagnosis if there is clinical suspicion of other sleep disorders, neuromuscular diseases, congestive heart failure, respiratory diseases, opioid use, obesity hypopnea syndrome and other serious concomitant diseases.
Home sleep apnea test (HSAT): HSAT includes type II and III portable sleep monitoring, which are clinically used for the diagnosis of high suspicion of moderate to severe OSA. HSAT is easy to operate, low cost, not limited by beds, less impact on patient sleep than PSG, no need for technicians to be on duty, and has high sensitivity and specificity, and can also play an important role in telemedicine.
1.?Type IV sleep monitoring: Type IV sleep monitoring takes continuous single/double signal channel recording, which can continuously record 1 or 2 physiological parameters, and the most commonly collected signal is pulse oxygen saturation. Type IV sleep monitoring is a simple, objective OSA screening tool that is closer to the natural sleep state, so patients have a high degree of acceptance and accessibility.
A domestic study comparing patients with type IV wearable devices with PSG showed that this single-channel oxygen saturation type IV sleep monitoring has good sensitivity and specificity for the diagnosis of OSA. Taking AHI ≥ 5 times/h as the diagnostic criteria, its sensitivity and specificity to OSA diagnosis were 93% and 77%, respectively. When AHI ≥ 15 times/h as the diagnostic criteria for moderate to severe OSA, the sensitivity and specificity were 92% and 89%, respectively.
Studies have shown that the oxygen reduction index monitored by the type IV sleep monitoring device alone, or in combination with the STOP-Bang questionnaire, is significantly better than the STOP-Bang questionnaire alone in screening OSA, especially in mild OSA. The U.S. Prevention Working Group reviewed previous studies and found that while type IV sleep monitoring devices were inconsistent in estimating actual AHI, they were generally accurate in diagnosing OSA.