如何准确判读PSG报告

“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 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.”Laffael ChenProduct Manager如何准确判读PSG报告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 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.”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 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 or other health 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 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 intended as a 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 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 substitute for advice 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 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 information 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 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 information service only and is 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/hrPLMI:0ConfidentialLaffael,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 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.”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“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 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.”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,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 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.”案例 1-睡眠数量和质量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/hrPLMI:0TST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 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 intended as a substitute for advice from a registered physician or other health care professional.”案例 1-重新做 PSGAHI: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/hrPLMI: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 14,2008“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 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.”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 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 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 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 information service only and is not intended 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:56.2PLMI:0没有REM和深睡眠睡眠效率低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 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.”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 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 or other health care professional.”没有REM睡眠RW1234Cn.AO b.AM x.AHypUnsRE RA+5+5+5+5+5+5SpO 210040IP A PE P A PO 2502 05FLBR+10SLEEP STAGE SUMMARY APNEA GRAPH SpO2CPAP/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 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 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.”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 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 or other health 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 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 substitute 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:58.7PLMI:0AHI是否精确?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 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 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 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.”睡眠评分是如何进行的?原始数据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 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 sec epochEOGEEGEMG睡眠分期2 min epochConfidentialLaffael,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 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.”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 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 from a registered physician 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 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 or other health 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/TST2.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 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 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.”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 Index)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 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 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:58.7PLMI:0高的微觉醒指数REM和慢波睡眠少睡眠效率低高估了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 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.”PSG的结果是否能够指导治疗？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 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.”28岁男性，以往无健康问题 患者主诉白天过度嗜睡和夜间睡眠时打鼾和憋气 体格检查：BMI 27.2鼻:鼻中隔偏向右侧，下鼻甲肥大软腭低，扁桃体：2级 改良马氏评分：4案例 4 睡眠体位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 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.”案例 4 睡眠体位AHI:20.9最低血氧:69%Total Sleep time:448.5minTime in Bed:471.5min睡眠效率 :92.7%3期和4期:7.3%REM:25.3%微觉醒指数:30.6PLMI:9/hr仰卧位占据了整个睡眠时间的 49.2%.仰卧位:37.8/hr非仰卧位:4.5/hrConfidentialLaffael,09 14,2008“This document is the confidential and proprietary information of Philips Respironics and may not be