缓慢进展性神经肌肉疾病中夜间经皮二氧化碳与血氧饱和度模式的视觉分类：一项推导与可行性研究。
Visual classification of nocturnal transcutaneous CO2 and oximetry patterns in slowly progressive neuromuscular diseases: a derivation and feasibility study.
文献信息
| PMID | 42843124 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Lucas Saulnier |
| 作者单位 | Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, GHU Paris-Saclay, Hôpital Raymond Poincaré, FHU UMANHYS, Garches, France. |
| 期刊 | Sleep medicine |
| SCI 分区 | Q1 |
| IF | 4.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 睡眠呼吸障碍在神经肌肉疾病（NMD）受试者中高度普遍。我们假设对夜间经皮二氧化碳（TcCO2）监测进行视觉分析可帮助医生识别不同的呼吸表型。本研究旨在推导缓慢进展性神经肌肉疾病患者夜间经皮二氧化碳与血氧饱和度模式的视觉分类，并评估其可行性与评分者间一致性。
方法： 回顾性研究纳入149例未接受无创通气的NMD受试者，均接受整夜TcCO2监测。三名研究者独立审阅每份TcCO2曲线并分配以下类型：无夜间高碳酸血症（NH-）、仅高碳酸血症峰簇（cluNH）、无峰簇的持续性夜间高碳酸血症（ConNH）、以及伴有峰簇的持续性夜间高碳酸血症（ConNH伴cluNH）。同时从SpO2曲线推导类型：无或有锯齿状氧降（OD-或OD+）。重叠定义为任何形式的夜间高碳酸血症伴OD+。最终分类基于多数一致，无多数时进行共识裁定。评估评分者间一致性。比较各类型的人口学数据以及动脉血气、肺功能检测和呼吸polygraphy参数。
结果： TcCO2分类的总体一致性kappa=0.68（95% CI，0.61-0.75），OD-/OD+为kappa=0.55（95% CI，0.44-0.65），分别有71.1%和72.5%的记录达到完全一致。高碳酸血症峰簇和锯齿状模式的一致性为中等。校正后，高碳酸血症类型仍与较低的用力肺活量和仰卧位用力肺活量以及较高的日间PaCO2和碳酸氢盐相关，OD+仍与较高的呼吸暂停低通气指数相关。
结论： 对整夜TcCO2和SpO2记录的视觉分类是可行的，对高碳酸血症峰簇和锯齿状血氧模式显示出中等评分者间一致性。视觉类型与选定的生理特征相关，但这些关联主要支持表面效度。需要前瞻性外部验证以确定该分类是否提供超出传统定量指标的信息或改善临床决策。
英文摘要
BACKGROUND: Sleep-disordered breathing is highly prevalent in subjects with neuromuscular diseases (NMD). We hypothesized that visual analysis of nocturnal transcutaneous CO2 (TcCO2) monitoring could help physicians identify distinct respiratory phenotypes. This study aimed to derive a visual classification of nocturnal transcutaneous CO2 and oximetry patterns in patients with slowly progressive neuromuscular diseases and to assess its feasibility and inter-rater agreement.
METHODS: Retrospective study of 149 NMD subjects, naive to noninvasive ventilation, who underwent full-night TcCO2 monitoring. Three investigators independently reviewed each TcCO2 tracing and assigned a profile: absence of nocturnal hypercapnia (NH-), clusters of hypercapnic peaks only (cluNH), constant nocturnal hypercapnia without clusters (ConNH), and constant nocturnal hypercapnia associated with clusters (ConNH with cluNH). Profiles were also derived from the SpO2 tracing: absence or presence of an oxygen drop with a sawtooth profile (OD- or OD+). Overlap was defined as any form of nocturnal hypercapnia associated with OD+. Final classification was based on majority agreement, with consensus adjudication when no majority existed. Inter-rater agreement was assessed. Each profile was compared in terms of demographic data and parameters from arterial blood gases, pulmonary function testing, and respiratory polygraphy.
RESULTS: Overall agreement was kappa = 0.68 (95% CI, 0.61-0.75) for TcCO2 classification and kappa = 0.55 (95% CI, 0.44-0.65) for OD-/OD+, with complete agreement in 71.1% and 72.5% of recordings, respectively. Agreement was moderate for hypercapnic clusters and the sawtooth pattern. After correction, hypercapnic profiles remained associated with lower vital and supine vital capacities and higher daytime PaCO2 and bicarbonate than NH-, OD + remained associated with a higher apnea-hypopnea index.
CONCLUSIONS: Visual classification of overnight TcCO2 and SpO2 recordings was feasible and showed moderate inter-rater agreement for hypercapnic clusters and the sawtooth oximetry pattern. The visual profiles were associated with selected physiological characteristics, but these associations primarily support face validity. Prospective external validation is required to determine whether this classification provides information beyond conventional quantitative indices or improves clinical decision-making.