如何准确判读PSG报告课件.ppt

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 and

2、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“Th

3、is 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

4、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

5、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 Respironi

6、cs 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

7、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 permissio

8、n 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 physic

9、ian 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.Phi

10、lips 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 profe

11、ssional.”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

12、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 f

13、rom 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 Philip

14、s 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

15、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

16、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 entit

17、y 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

18、 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 ot

19、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 su

20、bstitute 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 o

21、ther 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 s

22、ubstitute 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 confidentia

23、l 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 p

24、rior 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%

25、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 Re

26、spironics 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

27、.”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

28、 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

29、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 ma

30、y 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 genera

31、l 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

32、 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

33、 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

34、.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

35、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 profession

36、al.”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 Phi

37、lips 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

38、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。Conf

39、identialLaffael,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 re

40、gard 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：BM

41、I 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 Respiro

42、nics 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

43、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

44、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 substi

45、tute 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 Respi

46、ronics 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 provide

47、d 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 Respir

48、onics 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

49、 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

50、 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