这项荟萃分析的目的是分析外周动脉眼压测定(PAT)和多导睡眠图(PSG)研究之间呼吸暂停低通气指数(AHI)测定的一致性。
从研究报告的Bland-Altman图提取的平均AHI偏差和标准偏差在荟萃分析中汇总,然后使用PSGAHI作为参考,通过PAT计算AHI确定中极限一致性的百分比误差。使用个体参与者数据(在研究中报告)计算Cohen的kappa,以评估PSG和PAT对睡眠呼吸暂停严重程度的一致性,并使用PSGAHI作为参考,计算PAT在不同AHI阈值下的敏感性和特异性。
来自17项研究和1,318名参与者(均同时接受PSG并使用WatchPAT设备),合并平均值AHI偏差为0.30(标准误差[SE],0.74),计算出WatchPATAHI百分比误差为230%。PSG和WatchPAT研究对没有睡眠呼吸暂停的患者进行分类的CohenKappa协议的荟萃分析,温和,中度,或严重的睡眠呼吸暂停严重程度为0.45(SE,0.06),0.29(SE,0.05),0.25(SE,0.07),和0.64(SE,0.05),分别。在AHI阈值为5、15和30个事件/h时,WatchPAT研究显示,合并的敏感性和特异性分别为94.11%和43.47%,92.21%和72.39%,74.11%和87.10%,分别。在任何AHI阈值下,似然比均不显着。
这项荟萃分析的结果表明,WatchPAT和PSG测量AHI之间存在临床上显著的不一致,通过PAT研究,严重的睡眠呼吸暂停严重程度错误分类,和较差的诊断测试性能。
IftikharIH,FinchCE,ShahAS,奥甘斯坦CA,IoachimescuOC.外周动脉眼压测定诊断测试性能的荟萃分析。JClinSleepMed.2022年;18(4):1093-1102。
The objective of this meta-analysis was to analyze agreement in apnea-hypopnea index (AHI) determination between peripheral arterial tonometry (PAT) and polysomnography (PSG) studies.
Mean AHI bias and standard deviation extracted from Bland-Altman plots reported in studies were pooled in a meta-analysis, which was then used to calculate percentage errors of limit agreement in AHI determination by PAT using PSG AHI as the reference. Individual participant data (where reported in studies) were used to compute Cohen\'s kappa to assess agreement between PSG and PAT on sleep apnea severity and for computing the sensitivity and specificity of PAT at different AHI thresholds using PSG AHI as the reference.
From 17 studies and 1,318 participants (all underwent simultaneous PSG and use of the WatchPAT device), a pooled mean AHI bias of 0.30 (standard error [SE], 0.74) and a WatchPAT AHI percentage error of 230% was calculated. The meta-analysis of Cohen\'s kappa for agreement between PSG and WatchPAT studies for classifying patients with no sleep apnea, mild, moderate, or severe sleep apnea severity was 0.45 (SE, 0.06), 0.29 (SE, 0.05), 0.25 (SE, 0.07), and 0.64 (SE, 0.05), respectively. At AHI thresholds of 5, 15 and 30 events/h, WatchPAT studies showed pooled sensitivities and specificities of 94.11% and 43.47%, 92.21% and 72.39%, and 74.11% and 87.10%, respectively. Likelihood ratios were not significant at any AHI threshold.
The results of this meta-analysis suggest clinically significant discordance between WatchPAT and PSG measurements of AHI, significant sleep apnea severity misclassification by PAT studies, and poor diagnostic test performance.
Iftikhar IH, Finch CE, Shah AS, Augunstein CA, Ioachimescu OC. A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies. J Clin Sleep Med. 2022;18(4):1093-1102.