เวอร์ชันเก่านี้เผยแพร่เมื่อ 2022-03-14 โปรดอ่าน เวอร์ชันล่าสุด
Association between Oxygen Saturation by Pulse Oximetry and Respiratory Disturbance Index (RDI) and Apnea-Hypopnea Index (AHI) among Adult Snorer Patients
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เผยแพร่แล้ว:
มี.ค. 14, 2022
เวอร์ชัน:
2022-03-14 (1)
Main Article Content
บทคัดย่อ
ความสัมพันธ์ระหว่างระดับความอิ่มตัวของออกซิเจนของชีพจรที่ปลายนิ้ว และดัชนีการหายใจถูกรบกวน และดัชนีการหยุดหายใจ-หายใจแผ่วเบา ในผู้ป่วยที่มีภาวะนอนกรน
ภัทร์ปรียา เมืองสุวรรณ พบ.* คณิต มันตาภรณ์ พบ.* ชัย อยู่สวัสดิ์ พบ.*
บทคัดย่อ
ภาวะ obstructive sleep apnea (OSA) นั้น พบได้บ่อย โดยการตรวจแบบ Polysomnography (PSG) แต่ยังมีปัญหาในการคัดกรองผู้ป่วยผู้ใหญ่ที่มีภาวะนอนกรนให้ได้ตรวจ PSG เร็วขึ้น
วัตถุประสงค์ในการวิจัย
เพื่อศึกษาความสัมพันธ์ระหว่างระดับความอิ่มตัวของออกซิเจนของชีพจรที่ปลายนิ้ว (SpO2) และดัชนีการหายใจถูกรบกวน (RDI) และ ดัชนีการหยุดหายใจ-หายใจแผ่วเบา (AHI) และ ระดับ SpO2ที่ต่ำสุด (MinSpO2) สำหรับการคัดกรองผู้ป่วยผู้ใหญ่ที่มีภาวะนอนกรนเพื่อส่งนัด polysomnography (PSG) เร็วขึ้น
วิธีการวิจัย
การศึกษาแบบ retrospective ในข้อมูล PSG ของผู้ป่วยผู้ใหญ่ที่มีภาวะนอนกรน 1,159 ราย ณ ภาควิชาโสต ศอ นาสิกวิทยา คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี มหาวิทยาลัยมหิดล
ผลการวิจัย
ก. มีความสัมพันธ์แบบตรงกันข้าม ระหว่างระดับ SpO2 แบบต่ำสุด และ RDI และ AHI
ข. มีความสัมพันธ์ระหว่างระดับ SpO2 แบบต่ำสุด และ RDI โดย พื้นที่ใต้เส้นโค้ง (AUC) 0.75 และ ความสัมพันธ์ระหว่าง ระดับ SpO2 แบบต่ำสุด และ AHI โดย AUC 0.79
ค. มีความแตกต่างอย่างมีนัยสำคัญอย่างสูง p < 0.001 (OR 1.09, 95 % CI, 1.07 - 1.11) ระหว่างระดับ SpO2 แบบต่ำสุดในกลุ่ม RDI ≥ 15 ต่อ ชม. และ กลุ่ม RDI < 15 ต่อ ชม. และ มีความแตกต่างอย่างมีนัยสำคัญอย่างสูง p < 0.001 (OR 1.12, 95 % CI, 1.09 - 1.14) ระหว่างระดับ SpO2 แบบต่ำสุดในกลุ่ม AHI ≥ 15 ต่อ ชม. และ กลุ่ม AHI < 15 ต่อ ชม.
ง. SpO2 แบบต่ำสุดที่อาจนำมาใช้ในการคัดกรอง คือ 81 % หรือ 79.62 %
ข้อสรุปผลการวิจัย
- มีความสัมพันธ์ระหว่างระดับ SpO2 แบบต่ำสุด และ RDI และ มีความสัมพันธ์ระหว่างระดับ SpO2 แบบต่ำสุด และ AHI
- ถึงแม้ว่า SpO2 แบบต่ำสุดที่ 81 % หรือ 79.62 % อาจมาใช้ในการคัดกรองผู้ป่วยผู้ใหญ่ที่มีภาวะนอนกรนให้ได้ตรวจ PSG เร็วขึ้น แนะนำให้ใช้ 80 % หรือ 70% โดยขึ้นอยู่กับปริมาณผู้ที่รอคอยการตรวจว่ามีมากเพียงใด
- การคัดกรองนี้ใช้ได้ในผู้ป่วยผู้ใหญ่ที่มีภาวะนอนกรนในช่วงที่มีการคอยตรวจ PSG มากเกินไป
คำสำคัญ
obstructive sleep apnea, oxygen desaturation, lowest, minimal, minimum, polysomnography, pulse oximetry, screening, snorer, snore, AHI, OSA, PSG, RDI, SDB, SpO2, waiting-list
Article Details
รูปแบบการอ้างอิง
เมืองสุวรรณ ภ. (2022). Association between Oxygen Saturation by Pulse Oximetry and Respiratory Disturbance Index (RDI) and Apnea-Hypopnea Index (AHI) among Adult Snorer Patients. วารสารหู คอ จมูก และใบหน้า, 22(2). สืบค้น จาก https://he02.tci-thaijo.org/index.php/rcotJ/article/view/255104
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ต้นฉบับที่ส่งมาพิจารณายังวารสารหู คอ จมูก และใบหน้า จะต้องไม่อยู่ในการพิจารณาของวารสารอื่น ในขณะเดียวกันต้นฉบับที่จะส่งมาจะผ่านการอ่านโดยผู้ทรงคุณวุฒิ หากมีการวิจารณ์หรือแก้ไขจะส่งกลับไปให้ผู้เขียนตรวจสอบแก้ไขอีกครั้ง ต้นฉบับที่ผ่านการพิจารณาให้ลงตีพิมพ์ถือเป็นสมบัติของวารสารหู คอ จมูกและใบหน้า ไม่อาจนำไปลงตีพิมพ์ที่อื่นโดยไม่ได้รับอนุญาต
ตารางแผนภูมิ รูปภาพ หรือข้อความเกิน 100 คำที่คัดลอกมาจากบทความของผู้อื่น จะต้องมีใบยินยอมจากผู้เขียนหรือผู้ทรงลิขสิทธิ์นั้นๆ และใหร้ะบุกำกับไว้ในเนื้อเรื่องด้วย
เอกสารอ้างอิง
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2. Puvanendran K, Goh KL. From snoring to sleep apnea in a Singapore population. Sleep Res Online. 1999;2(1):11-14.
3. Ohta Y, Okada T, Kawakami Y, Suetsugu S, Kuriyama T. Prevalence of risk factors for sleep apnea in Japan: a preliminary report. Sleep. 1993; 16(8 Suppl):S6-7.
4. Wali SO, Abaalkhail BA. Prevalence and predictors of habitual snoring in a sample of Saudi middle-aged adults. Saudi Med J. 2015;36(8):920-7.
5. Neruntarat C, Chantapant S. Prevalence of sleep apnea in HRH Princess Maha Chakri Srinthorn Medical Center, Thailand. Sleep Breath. 2011;15(4):641-8.
6. Mirrakhimov AE, Sooronbaev T, Mirrakhimov EM. Prevalence of obstructive sleep apnea in Asian adults: a systematic review of the literature. BMC Pulm Med. 2013;13:10. Published online 2013 Feb 23. Doi: 10.1186/1471-2466-13-10.
7. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14.
8. Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventative Services Task Force. JAMA. 2017;317(4):407-14. Doi:10.1001/jama.2016.20325
9. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230-5.
10. Bixler EO, Vgontzas AN, Lin HM, Have TT, Leiby BE, Vela-Bueno A, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 2000;160(15):2289-95.
11. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504.
12. Bianchi MT, Lipoma T, Darling C, Alamedddine Y, Westover MB. Automated Sleep Apnea Quantification Based on Respiratory Movement. Int J Med Sci. 2014;11(8):796-802.
13. Goyal M, Johnson J. Obstructive sleep apnea diagnosis and management. Mo Med. 2017;114(2):120-4.
14. https://aasm.org/resources/clinicalguidelines/ diagnostic-testing-osa.pdf
15. Editors. Sleep Apnea Association and The Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand: “Guideline for Development of Diagnosis and Treatment of Snoring and Obstructive Sleep Apnea in Thailand for Adults”, 2017.
16. Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006;29(3):375-80.
17. The Report of an American Academy of Sleep Medicine Task Force for American Academy of Sleep Medicine (AASM). Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667-89.
18. Redline S, Kapur VK, Sanders MH, Quan SF, Gottlieb DJ, Rapoport DM, et al. Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment. Am J Respir Crit Care. 2000;161:369-74.
19. Iber C, Ancoli-Israel S, Chesson AL, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events. Rules, Terminology and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine, 2007.
20. Redline S, Budhiraja R, Kapur V, Marcus CL, Mateika JH, Mehra R, et al. The scoring of respiratory events in sleep: reliability and validity. J Clin Sleep Med. 2007;3:169-200.
21. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597-619.
22. Berry RB, Brooks R, Gamaldo CE, Harding SM, Llyod RM, Marcus C, et al. for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specifications. Version 2.1. www.aasmnet.org. Darien, Illinois: American Academy of Sleep Medicine. 2014.
23. Riley RW, Powell NB, Guilleminault C. Maxillofacial surgery and nasal CPAP. A comparison of treatment for obstructive sleep apnea syndrome. Chest. 1990;98(6):1421-5.
24. Maisel F, Antonelli PJ, Iber C, Mahowald M, Wilson KS, Fiedler B, Schluter J. Uvulopalatopharyngoplasty for obstructive sleep apnea: a community's experience. Laryngoscope. 1992;102(6):604-7.
25. Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D. Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000;122(1):71-4.
26. Patel AV, Hwang D, Masdeu MJ, Chen GM, Rapoport DM, Ayappa I. Predictors of response to a nasal expiratory resistor device and its potential mechanisms of action for treatment of obstructive sleep apnea. J Clin Sleep Med. 2011;7:13-22.
27. Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D. Impact of nasal obstruction on obstructive sleep apnea, Otolaryngol Head Neck Surg. 2011;144(6):1000-4.
28. Dixon JB, Schachter LM, O'Brien PE. Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes (Lond). 2005;29(9):1048-54.
29. Cillo JE Jr, Finn R, Dasheiff RM. Combined open rhinoplasty with spreader grafts and laser-assisted uvuloplasty for sleep-disordered breathing: long-term subjective outcomes. J Oral Maxillofac Surg. 2006;64(8):1241-7.
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