如何准确判读PSG报告

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 如何准确判读psg报告 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.” 在看完报告后我们会下什么样的结论？ 1.ahi是否精确? 2.实际的ahi比报告中的更好/更差？ 3.psg报告如何指导

5、治疗？ 4.是否还有其他原因导致患者的症状，而手术或cpap治疗 无效？ (如. plms, 发作性睡病导致的嗜睡) 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.” 观察患者睡眠的不同方法 1. 患者的健康问题，心理问题和睡眠历史 2. 患者导联的连接和导联的数量 3. 回顾睡眠日志（如患者平时凌晨2点开始睡觉，psg开始在 10点） 4. 开灯和关灯 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更精确? 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是否精确? 1. 例.1 osa患者临床症状很严重，但是psg报告正常 2. 例.2 psg 诊断重度 osa, 但是患者没有症状 3. 除了 ahi 和氧减是否还有其他的数据决定ahi的精确度? 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.” 睡眠结构图 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)- 躺在床上的时间. total recording time (trt)- 总的记录时间. total sleep time (tst)- 判定为睡眠的总时间. 睡眠效率- tst/tib100%或tst/trt100%. 健康成人 90%. 睡眠潜伏期- 从关灯至睡眠开始的时间.正常20 分钟. rem 潜伏

16、期- 从睡眠开始到第一个屏rem睡眠期，通常在 90-120 分钟. wake after sleep onset (waso)- 在睡眠开始后判定为觉醒的总时间. 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% 微觉醒指数 : 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.” 异常的睡眠效率 高的睡眠效率 催眠 睡眠反弹 fne反效应 低的睡眠效率 首夜效应 (fne) 环境干扰 焦虑/抑郁 精神兴奋药物 睡眠紊乱 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.” 首夜效应 睡眠质量差 更多的微觉醒 睡眠效率低 深睡眠 & rem睡眠更少 - 更多的浅睡眠 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-睡眠数量和质量 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% 微觉醒指数 : 22/hr plmi: 0 tst太低 (至少 2-4小时) 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% 微觉醒指数 : 9.9/hr plmi: 0 睡眠时间提高了 睡眠效率提高了 ahi 5 睡眠质量更佳 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.” 结论 由于首夜效应，这个病人睡眠质量较差。 首夜效应：人们在首次进入一个新环境时较难入眠。记录的 短暂睡眠时间也许并不能完全代表患

28、者的实际情况。 重复进行的睡眠研究更准确地代表了患者的实际睡眠情况， 而且ahi及血氧也更准确。这个患者的诊断为中度阻塞性睡 眠呼吸暂停。 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岁男性，以往无健康问题. 妻子抱怨其打鼾严重。有时患者白天严重嗜睡。 体格检查： bmi 30.5 鼻: 下鼻甲肥大 软腭低，扁桃体小，1级 改良马氏评分：4级 案例 2-rem缺失的影响 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缺失的影响 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 微觉醒指数 : 56.2 plmi: 0 没有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.” 评估psg报告 观察患者的睡眠时间及质量，我们发现 1. 总的睡眠时间tst充足，297.5分钟 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）觉醒指数：40.2/小时 5. 睡眠结构片段化 虽然睡眠时间充足，但仍提示睡眠质量差。 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.” 没有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 锯齿状锯齿状 没有没有rem 阻塞性睡眠呼吸暂停阻塞性睡眠呼吸暂停 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期阻塞性睡眠呼吸暂停更严重 由于rem缺失，ahi可能被低估了 这种情况通常发生在分夜研究中，和整夜研究对比，分夜研 究中rem期睡眠通常会缺失或比

40、预期更少。 经过治疗后rem期睡眠会改善，但是比较治疗前的rem期缺 失，治疗后的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岁男性，以往没有健康问题。 患者抱怨白天过度嗜睡，并有打鼾和夜间憋气发生。 体格检查： bmi 29.8 鼻: 正常 软腭低，扁桃体小，2级 改良马氏评分：4 案例 3 微觉醒 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 微觉醒 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% 微觉醒指数 : 58.7 plmi: 0 ahi是否精确? 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.” 评估psg报告 观察患者的睡眠总量及质量，我们发现 1. 睡眠总量处于临界点 2. 睡眠效率下降 2. 慢波睡眠及rem睡眠少于正常水平 3. 觉醒指数极高 58.7/小时 4. 睡眠结构片段化 以上提示了患者睡眠

47、质量较差，医生需慎重对待这些数据。 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.” 睡眠评分是如何进行的? 原始数据

49、记录在电脑中或者纸上 每一页 (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、 睡眠评分是如何进行的? 视觉的回顾和每个30秒的屏判定一个睡眠期 - epoch多数原则 显著的事件需要被注意 微觉醒 呼吸, 心脏 肢体运动 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.” 觉醒期呼吸暂停的判定 呼吸暂停呼吸暂停 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.” 过量微觉醒的影响 当呼吸暂停发生在判定为觉醒期时 1. ahi 呼吸暂停和低通气的总次数/tst 2. 如果有较多的觉醒次数，这个epoch被判定为觉醒期w，那 么就可能会有一定数量的有意义的睡眠期没有被解读出来。 3. 记录的总的睡眠时间tst也许就少于实际情况。 4. 许多较短时间的微觉醒频繁的发生而不是持续较长时间的觉 醒导致睡眠效率降低 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.” 高的微觉醒指数 微觉醒指数 (总的) 13.7 - 27.1/hr 属于正常 有报道显示，微觉醒指数6/hr 也可能导致eds，影响 白天的表现 1.呼吸事件微觉醒( r. arousal index) 2.周期性腿动微觉醒 (plm arousal i

60、ndex) 3.在psg上无法确定原因的微觉醒 fne, 疼痛, 环境, 药物 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