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Received:April 11, 2022 Published Online:January 20, 2023
Received:April 11, 2022 Published Online:January 20, 2023
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 |
| Author Name | Affiliation |
| XUShao-rong,PENGCheng,WANGYan,ZHAODan,WANGJian-qing | DepartmentofRespiratoryandCriticalCareMedicine，TianjinMedicalUniversityGeneralHospital，Tianjin，300052,China |
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