在三级高血压中心实施基于WatchPAT的阻塞性睡眠呼吸暂停诊断路径：一项可行性研究
Implementation of a WatchPAT-Based Diagnostic Pathway for Obstructive Sleep Apnea in a Tertiary Hypertension Center: A Feasibility Study.
文献信息
| PMID | 42924731 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Alexandre Boutigny |
| 作者单位 | Service de Physiologie -Explorations Fonctionnelles, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, Paris, France Paris France. |
| 期刊 | Journal of the American Heart Association |
| SCI 分区 | Q1 |
| IF | 6.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 阻塞性睡眠呼吸暂停（OSA）在高血压患者中普遍存在但诊断不足，影响30%至83%的患者。多导睡眠监测可及性有限延误诊断。我们在三级高血压单位评估了使用WatchPAT 300（一种基于外周动脉张力测定的家庭睡眠呼吸暂停检测）的整合诊断路径的可行性、诊断率及下游管理决策。
方法： 在这项单中心、前瞻性、观察性研究中，200例患者于2023年5月至2025年8月接受了门诊OSA评估。我们记录了临床变量、外周动脉张力测定数据和管理决策。一个亚组接受了确诊性实验室多导睡眠监测。患者被分类为无至轻度OSA（外周呼吸暂停低通气指数<15/小时）和中至重度OSA（≥15/小时）。
结果： 该路径达到97.5%（95% CI，94%-99%）的技术成功率，并将平均诊断时间缩短至3.5±4.5天，而实验室多导睡眠监测为154天。超过一半的队列被分诊：约30%直接符合治疗标准，22%被排除。在完成确诊性多导睡眠监测的患者中，83%（95% CI，61%-94%）最初分类为无至轻度的患者被重新分类为中至重度OSA，77%需要治疗。此外，症状与严重程度分离，打鼾-疲倦-观察到-压力-BMI-年龄-性别（STOP-Bag）与严重程度的关联在多重校正后不再显著。
结论： 基于外周动脉张力测定的家庭睡眠呼吸暂停检测优先模式可行且高效，消除了诊断延误。尽管对分诊明确病例有效，但高重新分类率强调了对较轻或模棱两可结果、疑似共病睡眠障碍或高STOP-Bag评分者几乎强制性的确诊性多导睡眠监测作用。这些数据反对仅基于症状的筛查来筛查高血压人群。
英文摘要
BACKGROUND: Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed in hypertension, affecting 30% to 83% of patients. Limited polysomnography access delays diagnosis. We evaluated the feasibility, diagnostic yield, and downstream management decisions of an integrated diagnostic pathway using WatchPAT 300, a peripheral arterial tonometry-based home sleep apnea test, in a tertiary hypertension unit.
METHODS: In this single-center, prospective, observational study, 200 patients underwent ambulatory OSA assessment from May 2023 through August 2025. We recorded clinical variables, peripheral arterial tonometry data, and management decisions. A subgroup underwent confirmatory in-laboratory polysomnography. Patients were classified as none-to-mild OSA (peripheral apneahypopnea index <15/h) and moderate-to-severe OSA (≥15/h).
RESULTS: The pathway achieved 97.5% (95% CI, 94%-99%) technical success and reduced the mean time-to-diagnosis to 3.5±4.5 days, versus 154 days for in-laboratory polysomnography. Over half of the cohort was triaged: ∼30% met treatment criteria directly, and 22% were ruled out. Among patients completing confirmatory polysomnography, 83% (95% CI, 61%-94%) initially classified as none-to-mild were reclassified as moderate-to-severe OSA, and 77% required treatment. Furthermore, symptoms were dissociated from severity, and Snoring-Tired-Observed-Pressure-BMI-Age-Gender (STOP-Bag) association with severity did not remain significant after multiplicity correction.
CONCLUSIONS: A peripheral arterial tonometry-based home sleep apnea test-first model is feasible and efficient, eliminating diagnostic delays. Although effective for triaging clear-cut cases, the high reclassification rate underscores the almost mandatory role of confirmatory polysomnography for milder or equivocal results, suspected comorbid sleep disorders, or high STOP-Bag score. These data argue against symptoms-based screening alone to screen populations with hypertension.