如何準(zhǔn)確判讀PSG報(bào)告

1、“this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material an

2、d it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” laffael chen product manager 如何準(zhǔn)確判讀psg報(bào)告 confidentiallaffael, 09 14

3、, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this mate

4、rial and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 在看完報(bào)告后我們會(huì)下什么樣的結(jié)論？ 1.ahi是否精確? 2.實(shí)際的ahi比報(bào)告中的更好/更差？ 3.psg報(bào)告如何指導(dǎo)

5、治療？ 4.是否還有其他原因?qū)е禄颊叩陌Y狀，而手術(shù)或cpap治療 無效？ (如. plms, 發(fā)作性睡病導(dǎo)致的嗜睡) confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips re

6、spironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other he

7、alth care professional.” 觀察患者睡眠的不同方法 1. 患者的健康問題，心理問題和睡眠歷史 2. 患者導(dǎo)聯(lián)的連接和導(dǎo)聯(lián)的數(shù)量 3. 回顧睡眠日志（如患者平時(shí)凌晨2點(diǎn)開始睡覺，psg開始在 10點(diǎn)） 4. 開燈和關(guān)燈 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any ot

8、her person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a

9、substitute for advice from a registered physician or other health care professional.” 如何使 ahi更精確? confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity w

10、ithout prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice

11、from a registered physician or other health care professional.” ahi是否精確? 1. 例.1 osa患者臨床癥狀很嚴(yán)重，但是psg報(bào)告正常 2. 例.2 psg 診斷重度 osa, 但是患者沒有癥狀 3. 除了 ahi 和氧減是否還有其他的數(shù)據(jù)決定ahi的精確度? confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be

12、reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general info

13、rmation service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 睡眠結(jié)構(gòu)圖 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or dis

14、tributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is

15、not intended as a substitute for advice from a registered physician or other health care professional.” sleep related indices time in bed (tib)- 躺在床上的時(shí)間. total recording time (trt)- 總的記錄時(shí)間. total sleep time (tst)- 判定為睡眠的總時(shí)間. 睡眠效率- tst/tib100%或tst/trt100%. 健康成人 90%. 睡眠潛伏期- 從關(guān)燈至睡眠開始的時(shí)間.正常20 分鐘. rem 潛伏

16、期- 從睡眠開始到第一個(gè)屏rem睡眠期，通常在 90-120 分鐘. wake after sleep onset (waso)- 在睡眠開始后判定為覺醒的總時(shí)間. 正常90%) 深睡眠少 rem睡眠少 ahi: 4.5/hr 最低血氧: 89% total sleep time: 105 min time in bed: 378 min 睡眠效率 : 28% % 3期和4期 : 13% % rem: 5% 微覺醒指數(shù) : 22/hr plmi: 0 confidentiallaffael, 09 14, 2008 “this document is the confidential and

17、proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior

18、 notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 異常的睡眠效率 高的睡眠效率 催眠 睡眠反彈 fne反效應(yīng) 低的睡眠效率 首夜效應(yīng) (fne) 環(huán)境干擾 焦慮/抑郁 精神興奮藥物 睡眠紊亂 confidentiallaffael, 09 14, 2008 “t

19、his document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and

20、it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 首夜效應(yīng) 睡眠質(zhì)量差 更多的微覺醒 睡眠效率低 深睡眠 & rem睡眠更少 - 更多的淺睡眠 confidentiallaffael, 0

21、9 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this

22、material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 案例 1-睡眠數(shù)量和質(zhì)量 ahi: 4.5/hr 最低血氧: 89% total sleep time: 105

23、 min time in bed: 378 min 睡眠效率 : 28% % 3期和4期 : 13% % rem: 5% 微覺醒指數(shù) : 22/hr plmi: 0 tst太低 (至少 2-4小時(shí)) 睡眠效率低 (正常 90%) 深睡眠少 rem睡眠少 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to

24、 any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intende

25、d as a substitute for advice from a registered physician or other health care professional.” 案例 1- 重新做 psg ahi: 16.3/hr 最低血氧: 80% total sleep time: 362min time in bed: 424min 睡眠效率 : 84.2% % 3期和4期 : 18.8% % rem: 13.1% 微覺醒指數(shù) : 9.9/hr plmi: 0 睡眠時(shí)間提高了 睡眠效率提高了 ahi 5 睡眠質(zhì)量更佳 confidentiallaffael, 09 14, 200

26、8 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material

27、and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 結(jié)論 由于首夜效應(yīng)，這個(gè)病人睡眠質(zhì)量較差。 首夜效應(yīng)：人們?cè)谑状芜M(jìn)入一個(gè)新環(huán)境時(shí)較難入眠。記錄的 短暫睡眠時(shí)間也許并不能完全代表患

28、者的實(shí)際情況。 重復(fù)進(jìn)行的睡眠研究更準(zhǔn)確地代表了患者的實(shí)際睡眠情況， 而且ahi及血氧也更準(zhǔn)確。這個(gè)患者的診斷為中度阻塞性睡 眠呼吸暫停。 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from

29、 philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician

30、or other health care professional.” 48歲男性，以往無健康問題. 妻子抱怨其打鼾嚴(yán)重。有時(shí)患者白天嚴(yán)重嗜睡。 體格檢查： bmi 30.5 鼻: 下鼻甲肥大 軟腭低，扁桃體小，1級(jí) 改良馬氏評(píng)分：4級(jí) 案例 2-rem缺失的影響 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distribu

31、ted to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not i

32、ntended as a substitute for advice from a registered physician or other health care professional.” 案例 2-rem缺失的影響 ahi: 56/hr 最低血氧: 89% total sleep time: 297.5min time in bed: 477min 睡眠效率 : 61.5% % 3期和4期 : 0 % rem: 0 微覺醒指數(shù) : 56.2 plmi: 0 沒有rem和深睡眠 睡眠效率低 confidentiallaffael, 09 14, 2008 “this document

33、is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject

34、 to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 評(píng)估psg報(bào)告 觀察患者的睡眠時(shí)間及質(zhì)量，我們發(fā)現(xiàn) 1. 總的睡眠時(shí)間tst充足，297.5分鐘 2. 睡眠效率下降61.5% 3. 慢波睡眠及rem睡眠少于正常值

35、 4. 高（微）覺醒指數(shù)：40.2/小時(shí) 5. 睡眠結(jié)構(gòu)片段化 雖然睡眠時(shí)間充足，但仍提示睡眠質(zhì)量差。 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironi

36、cs. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health ca

37、re professional.” 沒有rem睡眠 r w 1 2 3 4 cn.a o b.a m x.a hyp uns re ra +5 +5 +5 +5 +5 +5 spo 2 100 40 ip a pe p a po 2 5 0 2 0 5 fl b r +10 sleep stage summary apnea graph spo2 cpap/bilevel body position plms arousals 鋸齒狀鋸齒狀 沒有沒有rem 阻塞性睡眠呼吸暫停阻塞性睡眠呼吸暫停 confidentiallaffael, 09 14, 2008 “this document is

38、 the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject t

39、o change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” rem缺失 在rem期阻塞性睡眠呼吸暫停更嚴(yán)重 由于rem缺失，ahi可能被低估了 這種情況通常發(fā)生在分夜研究中，和整夜研究對(duì)比，分夜研 究中rem期睡眠通常會(huì)缺失或比

40、預(yù)期更少。 經(jīng)過治療后rem期睡眠會(huì)改善，但是比較治療前的rem期缺 失，治療后的rem期看上去低于正常水平。 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respi

41、ronics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other healt

42、h care professional.” 42歲男性，以往沒有健康問題。 患者抱怨白天過度嗜睡，并有打鼾和夜間憋氣發(fā)生。 體格檢查： bmi 29.8 鼻: 正常 軟腭低，扁桃體小，2級(jí) 改良馬氏評(píng)分：4 案例 3 微覺醒 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other per

43、son or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substit

44、ute for advice from a registered physician or other health care professional.” 案例 3 微覺醒 ahi: 78.7/hr 最低血氧: 84% total sleep time: 229min time in bed: 389min 睡眠效率 : 58.9% % 3期和4期 : 11.4% % rem: 5.7% 微覺醒指數(shù) : 58.7 plmi: 0 ahi是否精確? confidentiallaffael, 09 14, 2008 “this document is the confidential and p

45、roprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior

46、notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 評(píng)估psg報(bào)告 觀察患者的睡眠總量及質(zhì)量，我們發(fā)現(xiàn) 1. 睡眠總量處于臨界點(diǎn) 2. 睡眠效率下降 2. 慢波睡眠及rem睡眠少于正常水平 3. 覺醒指數(shù)極高 58.7/小時(shí) 4. 睡眠結(jié)構(gòu)片段化 以上提示了患者睡眠

47、質(zhì)量較差，醫(yī)生需慎重對(duì)待這些數(shù)據(jù)。 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no w

48、arranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 睡眠評(píng)分是如何進(jìn)行的? 原始數(shù)據(jù)

49、記錄在電腦中或者紙上 每一頁 (epoch) 是30 秒 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics

50、 makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 30 se

51、c epoch eogeegemg 睡眠分期 2 min epoch confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respi

52、ronics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

53、 睡眠評(píng)分是如何進(jìn)行的? 視覺的回顧和每個(gè)30秒的屏判定一個(gè)睡眠期 - epoch多數(shù)原則 顯著的事件需要被注意 微覺醒 呼吸, 心臟 肢體運(yùn)動(dòng) confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission f

54、rom philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physici

55、an or other health care professional.” 覺醒期呼吸暫停的判定 呼吸暫停呼吸暫停 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips re

56、spironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other he

57、alth care professional.” 過量微覺醒的影響 當(dāng)呼吸暫停發(fā)生在判定為覺醒期時(shí) 1. ahi 呼吸暫停和低通氣的總次數(shù)/tst 2. 如果有較多的覺醒次數(shù)，這個(gè)epoch被判定為覺醒期w，那 么就可能會(huì)有一定數(shù)量的有意義的睡眠期沒有被解讀出來。 3. 記錄的總的睡眠時(shí)間tst也許就少于實(shí)際情況。 4. 許多較短時(shí)間的微覺醒頻繁的發(fā)生而不是持續(xù)較長時(shí)間的覺 醒導(dǎo)致睡眠效率降低 ahi被高估了 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary informati

58、on of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. any medical

59、information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.” 高的微覺醒指數(shù) 微覺醒指數(shù) (總的) 13.7 - 27.1/hr 屬于正常 有報(bào)道顯示，微覺醒指數(shù)6/hr 也可能導(dǎo)致eds，影響 白天的表現(xiàn) 1.呼吸事件微覺醒( r. arousal index) 2.周期性腿動(dòng)微覺醒 (plm arousal i

60、ndex) 3.在psg上無法確定原因的微覺醒 fne, 疼痛, 環(huán)境, 藥物 confidentiallaffael, 09 14, 2008 “this document is the confidential and proprietary information of philips respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from philips respironics. philips