PDF(Pubmed)
Abstract：
Background: Respiratory effort is considered important in the context of the diagnosis of obstructive sleep apnoea (OSA), as well as other sleep disorders. However, current monitoring techniques can be obtrusive and interfere with a patient\'s natural sleep. This study examines the reliability of an unobtrusive tracheal sound-based approach to monitor respiratory effort in the context of OSA, using manually marked respiratory inductance plethysmography (RIP) signals as a gold standard for validation. Methods: In total, 150 patients were trained on the use of type III cardiorespiratory polygraphy, which they took to use at home, alongside a neck-worn AcuPebble system. The respiratory effort channels obtained from the tracheal sound recordings were compared to the effort measured by the RIP bands during automatic and manual marking experiments. A total of 133 central apnoeas, 218 obstructive apnoeas, 263 obstructive hypopneas, and 270 normal breathing randomly selected segments were shuffled and blindly marked by a Registered Polysomnographic Technologist (RPSGT) in both types of channels. The RIP signals had previously also been independently marked by another expert clinician in the context of diagnosing those patients, and without access to the effort channel of AcuPebble. The classification achieved with the acoustically obtained effort was assessed with statistical metrics and the average amplitude distributions per respiratory event type for each of the different channels were also studied to assess the overlap between event types. Results: The performance of the acoustic effort channel was evaluated for the events where both scorers were in agreement in the marking of the gold standard reference channel, showing an average sensitivity of 90.5%, a specificity of 98.6%, and an accuracy of 96.8% against the reference standard with blind expert marking. In addition, a comparison using the Embla Remlogic 4.0 automatic software of the reference standard for classification, as opposed to the expert marking, showed that the acoustic channels outperformed the RIP channels (acoustic sensitivity: 71.9%; acoustic specificity: 97.2%; RIP sensitivity: 70.1%; RIP specificity: 76.1%). The amplitude trends across different event types also showed that the acoustic channels exhibited a better differentiation between the amplitude distributions of different event types, which can help when doing manual interpretation. Conclusions: The results prove that the acoustically obtained effort channel extracted using AcuPebble is an accurate, reliable, and more patient-friendly alternative to RIP in the context of OSA.
摘要：
背景：在阻塞性睡眠呼吸暂停（OSA）的诊断中，呼吸努力被认为很重要，以及其他睡眠障碍。然而,目前的监测技术可以是突兀的和干扰患者的自然睡眠。这项研究检查了在OSA背景下基于不干扰气管声音的方法监测呼吸努力的可靠性，使用手动标记的呼吸电感体积描记术（RIP）信号作为验证的金标准。方法：总计，150名患者接受了III型心肺造影的使用培训，他们在家里使用，在脖子上磨损的AcuPebble系统旁边。在自动和手动标记实验中，将从气管声音记录获得的呼吸努力通道与RIP带测量的努力进行比较。共有133个中央Apnoeas,218阻塞性呼吸暂停，263例阻塞性低通气,在两种类型的通道中，随机选择的270个正常呼吸段进行混洗并由注册的多导睡眠技术专家（RPSGT）进行盲目标记。在诊断这些患者的情况下，RIP信号以前也由另一位专家临床医生独立标记。并且无法进入AcuPebble的努力通道。利用统计度量来评估利用声学获得的努力实现的分类,并且还研究每个不同通道的每个呼吸事件类型的平均振幅分布以评估事件类型之间的重叠。结果：对于两个记分员在黄金标准参考通道的标记中一致的事件，评估了声学努力通道的性能，显示平均灵敏度为90.5%，特异性为98.6%，与参考标准相比，具有盲专家标记的准确度为96.8%。此外,使用EmblaRemlogic4.0自动软件进行分类参考标准的比较，与专家标记相反，显示声学通道优于RIP通道（声学灵敏度：71.9％；声学特异性：97.2％；RIP灵敏度：70.1％；RIP特异性：76.1％）。不同事件类型的振幅趋势也表明，声通道在不同事件类型的振幅分布之间表现出更好的区别。这可以帮助进行手动解释。结论：结果证明，使用AcuPebble提取的声学获得的努力通道是准确的，可靠,在OSA的背景下，对患者更友好的替代RIP。
