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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Construcci&#243;n de un algoritmo para el diagn&#243;s-tico del s&#237;ndrome de apneas-hipopneas durante el sue&#241;o &#40;SAHS&#41; mediante el uso optimizado y secuencial de la pul-sioximetr&#237;a nocturna &#40;PN&#41; y la poligraf&#237;a respiratoria AutoSet&#174; &#40;AS&#41; en pacientes con alta sospecha cl&#237;nica de SAHS</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Realizaci&#243;n simult&#225;nea de una PN y AS en 145 pacientes con alta sospecha cl&#237;nica de SAHS &#40;al menos dos de&#58; roncopat&#237;a cr&#243;nica&#44; apneas presenciadas y repetidas&#44; y somnolencia diurna patol&#243;gica&#41;&#46; El diagn&#243;stico de SAHS se realiz&#243; con un &#237;ndice de apneas-hipopneas &#40;IAH&#41; &#40;obtenido mediante AS&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#46; Para la construcci&#243;n del algoritmo diag-n&#243;stico se siguieron los siguientes pasos&#58; c&#225;lculo de la preva-lencia de SAHS&#59; c&#225;lculo del mejor punto de corte diagn&#243;sti-co en el &#237;ndice de desaturaciones mayores o iguales al 4&#37; &#40;ID 4&#37;&#41; respecto al IAH&#59; an&#225;lisis del valor predictivo positi-vo &#40;VPP&#41; y negativo &#40;VPN&#41; para dicho valor y correlaci&#243;n y concordancia entre ID 4&#37; e IAH seg&#250;n la existencia y gra-vedad de SAHS</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prevalencia global de SAHS fue del 83&#44;4&#37;&#46; El mejor punto de corte se obtuvo para un ID 4&#37;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 &#40;sensibilidad &#91;S&#93;&#58; 82&#37;&#59; especificidad &#91;E&#93;&#58; 83&#37;&#41;&#46; Los VPP y VPN para la prevalencia calculada fueron de 0&#44;95 y 0&#44;29&#44; respectivamente&#46; La correlaci&#243;n y concordancia global entre el ID 4&#37; e IAH fue de 0&#44;84 y 0&#44;93&#44; respectivamente&#46; En pa-cientes sin SAHS fueron de 0&#44;49 y 0&#44;35&#44; y ambas aumenta-ron progresivamente en SAHS leves&#44; moderados y graves &#40;0&#44;90 y 0&#44;95&#44; respectivamente&#44; en SAHS graves&#41;&#46; Con todos estos datos se construy&#243; el algoritmo diagn&#243;stico seg&#250;n el cual la obtenci&#243;n de un ID 4&#37; <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30 en la PN &#40;S&#58; 72&#37;&#59; E&#58; 100&#37;&#41; evitar&#237;a la realizaci&#243;n de una AS posterior&#44; mientras que un ID 4&#37; &#60; 30 har&#237;a necesaria la realizaci&#243;n de estudios posteriores &#40;AS o PSG en caso de negatividad de la AS&#41;&#44; dada la alta prevalencia de SAHS en nuestra serie</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La utilizaci&#243;n secuencial de la PN y la AS permite ahorrar un n&#250;mero importante de estudios polisom-nogr&#225;ficos en poblaciones con alta sospecha cl&#237;nica de SAHS</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To construct an algorithm for the diagnosis of sleep apnea&#47;hypopnea syndrome &#40;SAHS&#41; based on the opti-mized sequential use of nocturnal pulse oximetry and respi-ratory polygraphy &#40;AutoSet&#174;&#44; AS&#41; in patients suspected of SAHS</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Simultaneous performance of pulse oximetry and AS in 145 patients highly suspected of SAHS &#40;at least two of the following signs or symptoms&#58; chronic snoring&#44; ob-servations of repeated apneic events&#44; and abnormal daytime drowsiness&#41;&#46; SAHS was diagnosed when the apnea&#47;hypopnea index &#40;AHI&#41; was greater than or equal to 10&#44; based on AS findings&#46; The diagnostic algorithm was obtained by calcula-ting the prevalence of SAHS&#44; calculating the best diagnostic cutoff point for a desaturation index greater than or equal to 4&#37; &#40;ID4&#37;&#41; based on the AHI&#59; analyzing the positive predic-tive value &#40;PPV&#41; and negative predictive value &#40;NPV&#41; for the cutoff and the correlation and agreement between ID4&#37; and the AHI depending on the presence and severity of SAHS</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The overall prevalence of SAHS was 83&#46;4&#37;&#46; The best cutoff point was obtained using ID4&#37; greater than or equal to 10 &#40;sensitivity 82&#37;&#59; specificity 83&#37;&#41;&#46; The PPV and NPV for the prevalence calculated were 0&#46;95 and 0&#46;29&#44; respectively&#46; The correlation between ID4&#37; and AHI was 0&#46;84&#59; overall agreement was 0&#46;93&#46; For patients who did not have SAHS&#44; the PPV was 0&#46;49&#44; and the NPV was 0&#46;35&#59; both gradually increased in cases of mild&#44; moderate and severe SAHS &#40;to 0&#46;90 and 0&#46;95&#44; respectively&#44; for severe SAHS&#41;&#46; Using these data we created a diagnostic algorithm accor-ding to which an ID4&#37; greater than or equal to 30 for noc-turnal pulse oximetry &#40;sensitivity 72&#37;&#44; specificity 100&#37;&#41; would indicate that AS testing would be unnecessary&#46; An ID4&#37; less than 30&#44; on the other hand&#44; would lead to further testing &#40;AS&#44; or polysomnography in the event of a negative AS&#41;&#44; based on the high prevalence of SAHS in our series</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The sequential use of nocturnal pulse oxi-metry and AS allows substantial savings of polysomnograp-hic testing in groups at high risk of SAHS</p>"
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Vol. 39. Issue 2.
Pages 74-80 (February 2003)
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Vol. 39. Issue 2.
Pages 74-80 (February 2003)
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Uso secuencial de la pulsioximetría nocturna y la poligrafía respiratoria (AutoSet®) para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en pacientes con alta sospecha clínica
Sequential use of nocturnal pulse oximetry and respiratory polygraphy (AutoSet®) for diagnosing sleep apnea/hypopnea syndrome in high risk patients
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M.A. Martínez Garcíaa,
Corresponding author
med013413@nacom.es

Correspondencia: Unidad de Neumología. Servicio de Medicina Interna. Hospital General de Requena.Paraje Casa Blanca, s/n. 46340 Requena. Valencia. España
, J.J. Soler Cataluñab, P. Román Sánchezb
a Unidad de Neumología. Hospital General de Requena. Valencia
b Servicio de Medicina Interna. Hospital General de Requena. Valencia. España
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Article information
Objetivo

Construcción de un algoritmo para el diagnós-tico del síndrome de apneas-hipopneas durante el sueño (SAHS) mediante el uso optimizado y secuencial de la pul-sioximetría nocturna (PN) y la poligrafía respiratoria AutoSet® (AS) en pacientes con alta sospecha clínica de SAHS

Métodos

Realización simultánea de una PN y AS en 145 pacientes con alta sospecha clínica de SAHS (al menos dos de: roncopatía crónica, apneas presenciadas y repetidas, y somnolencia diurna patológica). El diagnóstico de SAHS se realizó con un índice de apneas-hipopneas (IAH) (obtenido mediante AS)=10. Para la construcción del algoritmo diag-nóstico se siguieron los siguientes pasos: cálculo de la preva-lencia de SAHS; cálculo del mejor punto de corte diagnósti-co en el índice de desaturaciones mayores o iguales al 4% (ID 4%) respecto al IAH; análisis del valor predictivo positi-vo (VPP) y negativo (VPN) para dicho valor y correlación y concordancia entre ID 4% e IAH según la existencia y gra-vedad de SAHS

Resultados

La prevalencia global de SAHS fue del 83,4%. El mejor punto de corte se obtuvo para un ID 4%=10 (sensibilidad [S]: 82%; especificidad [E]: 83%). Los VPP y VPN para la prevalencia calculada fueron de 0,95 y 0,29, respectivamente. La correlación y concordancia global entre el ID 4% e IAH fue de 0,84 y 0,93, respectivamente. En pa-cientes sin SAHS fueron de 0,49 y 0,35, y ambas aumenta-ron progresivamente en SAHS leves, moderados y graves (0,90 y 0,95, respectivamente, en SAHS graves). Con todos estos datos se construyó el algoritmo diagnóstico según el cual la obtención de un ID 4% =30 en la PN (S: 72%; E: 100%) evitaría la realización de una AS posterior, mientras que un ID 4% < 30 haría necesaria la realización de estudios posteriores (AS o PSG en caso de negatividad de la AS), dada la alta prevalencia de SAHS en nuestra serie

Conclusiones

La utilización secuencial de la PN y la AS permite ahorrar un número importante de estudios polisom-nográficos en poblaciones con alta sospecha clínica de SAHS

Palabras clave:
Síndrome de apneas-hipopneas durante el sue-ño
AutoSet®
Pulsioximetría nocturna
Algoritmo diagnóstico
Objective

To construct an algorithm for the diagnosis of sleep apnea/hypopnea syndrome (SAHS) based on the opti-mized sequential use of nocturnal pulse oximetry and respi-ratory polygraphy (AutoSet®, AS) in patients suspected of SAHS

Methods

Simultaneous performance of pulse oximetry and AS in 145 patients highly suspected of SAHS (at least two of the following signs or symptoms: chronic snoring, ob-servations of repeated apneic events, and abnormal daytime drowsiness). SAHS was diagnosed when the apnea/hypopnea index (AHI) was greater than or equal to 10, based on AS findings. The diagnostic algorithm was obtained by calcula-ting the prevalence of SAHS, calculating the best diagnostic cutoff point for a desaturation index greater than or equal to 4% (ID4%) based on the AHI; analyzing the positive predic-tive value (PPV) and negative predictive value (NPV) for the cutoff and the correlation and agreement between ID4% and the AHI depending on the presence and severity of SAHS

Results

The overall prevalence of SAHS was 83.4%. The best cutoff point was obtained using ID4% greater than or equal to 10 (sensitivity 82%; specificity 83%). The PPV and NPV for the prevalence calculated were 0.95 and 0.29, respectively. The correlation between ID4% and AHI was 0.84; overall agreement was 0.93. For patients who did not have SAHS, the PPV was 0.49, and the NPV was 0.35; both gradually increased in cases of mild, moderate and severe SAHS (to 0.90 and 0.95, respectively, for severe SAHS). Using these data we created a diagnostic algorithm accor-ding to which an ID4% greater than or equal to 30 for noc-turnal pulse oximetry (sensitivity 72%, specificity 100%) would indicate that AS testing would be unnecessary. An ID4% less than 30, on the other hand, would lead to further testing (AS, or polysomnography in the event of a negative AS), based on the high prevalence of SAHS in our series

Conclusions

The sequential use of nocturnal pulse oxi-metry and AS allows substantial savings of polysomnograp-hic testing in groups at high risk of SAHS

Keywords:
Sleep apnea-hypopnea syndrome
AutoSet®
Nocturnal pulse oximetry
Diagnostic algorithm
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