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投稿时间:2022-04-11 网络发布日期:2023-01-20
投稿时间:2022-04-11 网络发布日期:2023-01-20
中文摘要: 目的比较对不同年龄层阻塞性睡眠呼吸暂停(OSA)患者采用NoSAS评分、STOP-Bang问卷(SBQ)、Epworth嗜睡量表(ESS)筛查的实施和价值。
方法回顾性分析2017年1月至2021年12月就诊于天津医科大学总医院睡眠中心进行整夜多导睡眠监测(PSG)的打鼾患者1954例的临床资料。将1954例分为四个年龄段组:少年组41例,青年组818例,中年组925例,老年组170例。根据呼吸暂停低通气指数(AHI),将AHI5~15、>15~30、>30次/h分别判定为OSA轻度、中度和重度。收集患者的症状及人口学资料,计算NoSAS、ESS和SBQ得分,绘制受试者工作特征(ROC)曲线,比较3个量表的敏感度、特异度、阳性预测值和阴性预测值。
结果少年组中,在AHI>15、>30次/h时,NoSAS的AUC分别为0.780和0.922,均明显高于SBQ和ESS,对诊断中度和重度OSA有中度以上预测价值。青年组中,在AHI≥5、>15和>30次/h时,NoSAS(AUC分别为0.837、0.786、0.762)和SBQ(AUC分别为0.843、0.786、0.775),对诊断OSA及其严重程度均有中度预测价值。中年和老年组中,在AHI≥5次/h时,NoSAS的AUC分别为0.761、0.800,对诊断OSA的预测价值最高;AHI>15次/h时,SBQ的AUC分别为0.706、0.722,对诊断中重度OSA预测价值最高。以SBQ≥3为判定分界分别预测四个年龄段OSA患者时,其敏感度和阴性预测值大部高于NoSAS和ESS,但特异度大部呈ESS>NoSAS>SBQ。
结论在少年人群中,NoSAS适用于筛查中度和重度OSA患者。在青年人群中,SBQ和NoSAS筛查OSA及其严重程度的效果均较好,且SBQ更敏感。在中年和老年人群中,NoSAS筛查OSA的能力较好,但SBQ筛查中重度OSA效果更显著。临床应根据患者的年龄分层选择合适的量表作为OSA的筛查工具,以便更精准地筛查出OSA高风险人群。
中文关键词: 阻塞性睡眠呼吸暂停 NoSAS评分 Epworth嗜睡量表 STOP-Bang问卷 筛查 年龄
Abstract:ObjectiveTocomparethepredictivevalueofNoSASscore,STOP-BangQuestionnaire(SBQ)andEpworthsleepinessscale(ESS)inthescreeningofdifferentagespatientswithobstructivesleepapnea(OSA).
MethodsAretrospectiveanalysisoftheclinicaldataof1954snorerswhowenttothesleepcenterofTianjinMedicalUniversityGeneralHospitalforovernightpolysomnography(PSG)monitoringfromJanuary2017toDecember2021.Accordingtoage,therewere41casesinjuvenilegroup,818casesinyouthgroup,925casesinmiddle-agedgroupand170casesinelderlygroup.Accordingtotheapneahypopneaindex(AHI),5~15,>15~30and>30times/hofAHIweredeterminedasmild,moderateandsevereOSArespectively.AftercalculatingNoSAS,ESSandSBQscoresanddrawingtheROCcurveofthesubjects,thesensitivity,specificity,positivepredictivevalueandnegativepredictivevaluewereanalyzedandcomparedamongNoSAS,ESSandSBQscores.
ResultsWhenAHI>15and>30times/h,theAUCsofNoSAS(0.780,0.922,respectively)injuvenilegroupweresignificantlyhigherthanthoseofSBQandESS,withmorethanmoderatepredictivevalueforthediagnosisofmoderate-to-severeOSA.Inyouthgroup,whenAHI≥5,>15and>30times/h,AUSsofNoSAS(being0.837,0.786and0.762,respectively)andSBQ(being0.843,0.786and0.775,respectively)hadmoderatepredictivevalueforthediagnosisofOSAanditsseverity.Inmiddle-agedandelderlygroup,whenAHI≥5times/h,NoSAShadthehighestpredictivevalue,withanAUCvalueof0.761and0.800;andasAHI>15times/h,AUCofSBQwas0.706and0.722,respectively,whichhadthehighestpredictivevalueinthediagnosisofmoderateandsevereOSA.WhenSBQ≥3wasusedasthecutofftopredictOSAinfourdifferentagegroups,itssensitivityandnegativepredictivevalueweremostlyhigherthanthoseofNoSASandESS,butthespecificityofESSwasthehighest,followedbyNoSASandSBQ.
ConclusionIntheadolescentpopulation,NoSASaresuitableforscreeningpatientswithmoderateandsevereOSA.Intheyoungpopulation,SBQandNoSAShavebetterscreeningeffectsforOSAanditsseverity,andSBQismoresensitive.NoSAShasagoodscreeningabilityforOSAinmiddle-agedandelderlypopulation,butSBQhasamoresignificantscreeningeffectformoderateandsevereOSA.Inclinicalwork,appropriatescalesshouldbeselectedaccordingtotheagestratificationofpatientsasascreeningtoolforOSA,soastoscreenoutpeopleathighriskofOSAmoreaccurately.
keywords: Obstructivesleepapnea NoSASscore Epworthsleepinessscale STOP-Bangquestionnaire Screening Age
文章编号: 中图分类号:R56 文献标志码:A
基金项目:
Author Name | Affiliation |
XUShao-rong,PENGCheng,WANGYan,ZHAODan,WANGJian-qing | DepartmentofRespiratoryandCriticalCareMedicine,TianjinMedicalUniversityGeneralHospital,Tianjin,300052,China |
引用文本:
许绍蓉,彭程,王彦,赵丹,王建青.NoSAS评分、STOP-Bang问卷和Epworth嗜睡量表对不同年龄OSA患者的筛查价值[J].中国临床研究,2023,36(1):40-44.
许绍蓉,彭程,王彦,赵丹,王建青.NoSAS评分、STOP-Bang问卷和Epworth嗜睡量表对不同年龄OSA患者的筛查价值[J].中国临床研究,2023,36(1):40-44.