女性打鼾人群阻塞性睡眠呼吸暂停低通气综合征筛查模型的初步研究
|
摘要
目的探索女性打鼾人群的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)筛查模型。方法 2017年1月~2018年2月于北京协和医院收集223例行睡眠呼吸监测的打鼾女性,进行女性OSAHS的危险因素及打鼾情况的调查与分析,根据Logistic回归系数对各指标进行赋分,建立筛查模型,计算筛查模型的积分,绘制ROC曲线,评价筛查效果。结果 223例打鼾女性中有110例OSAHS患者和113例非OSAHS患者,体重指数(BMI)、月经状态、改良Mallampati分级(MMP)、打鼾年限及打鼾程度进入回归方程模型,P<0.05。赋分情况:BMI≥24.55 kg/m~2(3分),绝经(3分),MMP≥Ⅲ级(2分),打鼾年限≥10.25年(4分),重度打鼾(2分),该筛查模型积分范围为0~14分;ROC曲线下面积A为0.795,95%可信区间为(0.737,0.853),P<0.001,差异有统计学意义,筛查模型积分=7分时,约登指数最大为0.452,因此将7分作为最佳切分值。本筛查模型以呼吸暂停低通气指数(AHI)≥5次/h为诊断标准时,其灵敏度、特异度、阳性预测值和阴性预测值分别为70.9%、74.3%、72.6%和71.8%。结论通过对女性打鼾人群的OSAHS危险因素与打鼾情况的研究分析,建立了女性打鼾人群OSAHS筛查模型,有一定的临床应用价值。
Objective To investigate the obstructive sleep apnea hypopnea syndrome(OSAHS) screening model for female snorers. Methods The clinical data of 223 female snorers, that had conducted sleep monitor in Peking Union Medical College Hospital from January 2017 to February 2018, was analyzed to investigate the risk factors of OSAHS and snoring conditions. According to the Logistic regression coefficient, the indices were assigned, a screening model was established, the score of the screening model was calculated and the ROC curve was plotted to evaluate the screening effect. Results There were 110 females diagnosed with OSAHS and the other 113 females were not. There were statistically significant significance in the body mass index(BMI), menstrual status, modified Mallampati index(MMP), number of year of snoring and degree of snoring categorized into Logistic regression equation model(P < 0.05).The indices were assigned as BMI ≥ 24.55 kg/m2(3 points), menopause(3 points), MMP ≥ Ⅲ class(2 points), year of snoring ≥ 10.25 years(4 points), degree of snoring was severe(2 points). The screening model score ranged from 0 to14 points, the area under the ROC curve A was 0.795, the 95% confidence interval was(0.737, 0.853), which had significant difference(P < 0.001). When the score got 7 points, Youden index was 0.452 the maximum, so 7 points were taken as the best division point. When screening model in this study set apnea hypopnea index(AHI) ≥ 5 times/h as standard of diagnosis, the sensitivity, specificity, positive predictive value, and negative predictive value were 70.9%,74.3%, 72.6% and 71.8%. Conclusion Through this research of risk factors of OSAHS and snoring conditions of female snorers, the OSAHS screening model of female snorers is constructed, which has a certain clinical application value.
Objective To investigate the obstructive sleep apnea hypopnea syndrome(OSAHS) screening model for female snorers. Methods The clinical data of 223 female snorers, that had conducted sleep monitor in Peking Union Medical College Hospital from January 2017 to February 2018, was analyzed to investigate the risk factors of OSAHS and snoring conditions. According to the Logistic regression coefficient, the indices were assigned, a screening model was established, the score of the screening model was calculated and the ROC curve was plotted to evaluate the screening effect. Results There were 110 females diagnosed with OSAHS and the other 113 females were not. There were statistically significant significance in the body mass index(BMI), menstrual status, modified Mallampati index(MMP), number of year of snoring and degree of snoring categorized into Logistic regression equation model(P < 0.05).The indices were assigned as BMI ≥ 24.55 kg/m2(3 points), menopause(3 points), MMP ≥ Ⅲ class(2 points), year of snoring ≥ 10.25 years(4 points), degree of snoring was severe(2 points). The screening model score ranged from 0 to14 points, the area under the ROC curve A was 0.795, the 95% confidence interval was(0.737, 0.853), which had significant difference(P < 0.001). When the score got 7 points, Youden index was 0.452 the maximum, so 7 points were taken as the best division point. When screening model in this study set apnea hypopnea index(AHI) ≥ 5 times/h as standard of diagnosis, the sensitivity, specificity, positive predictive value, and negative predictive value were 70.9%,74.3%, 72.6% and 71.8%. Conclusion Through this research of risk factors of OSAHS and snoring conditions of female snorers, the OSAHS screening model of female snorers is constructed, which has a certain clinical application value.
引文
[1]Epstein LJ,Kristo D,Jr SP,et al.Clinical guideline for the evaluation,management and long-term care of obstructive sleep apnea in adults[J].JCSM,2009,5(3):263-276.
[2]Da SKV,Garcia RML,Lagoeiro JAJ,et al.Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care[J].Arq Brasil Card,2016,106(6):474-480.
[3]Young T,Evans L,Finn L,et al.Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middleaged men and women[J].Sleep,1997,20(9):705-706.
[4]Pataka A,Daskalopoulou E,Kalamaras G,et al.Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic[J].Sleep Med,2014,15(7):776-781.
[5]杜丽娜,李哲,唐向东.四种量表在阻塞性睡眠呼吸暂停综合征筛查中的应用价值[J].中华医学杂志,2015,95(42):3407-3410.
[6]Silva S,Abeyratne UR,Hukins C.Impact of gender on snorebased obstructive sleep apnea screening[J].Physiol Meas,2012,33(4):587-601.
[7]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.
[8]Friedman M,Tanyeri H,La RM,et al.Clinical predictors of obstructive sleep apnea[J].Laryngoscope,1999,109(12):1901-1907.
[9]Young T,Peppard PE,Gottlieb DJ.Epidemiology of obstructive sleep apnea:a population health perspective[J].Am J Respir Crit Care Med,2002,165(9):1217-1239.
[10]Sean H,Shyam S,Jerry A,et al.Body Mass Index,Gender,and Ethnic Variations Alter the Clinical Implications of the Epworth Sleepiness Scale in Patients with Suspected Obstructive Sleep Apnea[J].Open Respir Med J,2012,6:20-27.
[11]Lim YH,Choi J,Kim KR,et al.Sex-Specific Characteristics of Anthropometry in Patients With Obstructive Sleep Apnea:Neck Circumference and Waist-Hip Ratio[J].Ann Oto Rhinol Laryn,2014,123(7):517-523.
[12]Mohsenin V.Gender differences in the expression of sleepdisordered breathing:role of upper airway dimensions[J].Chest,2001,120(5):1442-1447.
[13]Rowley JA,Sanders CS,Zahn BR,et al.Gender differences in upper airway compliance during NREM sleep:role of neck circumference[J].J Appl Physiol,2002,92(6):2535-2541.
[14]Young T,Finn L,Austin D,et al.Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study[J].Am J Resp Crit Care Med,2003,167(9):1181-1185.
[15]Block AJ,Wynne JW,Boysen PG.Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women[J].Am J Med,1980,69(1):75-79.
[16]Mirer AG,Young T,Palta M,et al.Sleep-disordered breathing and the menopausal transition among participants in the Sleep in Midlife Women Study[J].Menopause(New York,N.Y.),2015,24(2):157-162.
[17]Bixler EO,Vgontzas AN,Lin HM,et al.Prevalence of sleepdisorderd breathing in women:effects of gender[J].Am J Crit Care Med,2001,163(3):608-613.
[18]Boynton G,Vahabzadeh A,Hammoud S,et al.Validation of the STOP-BANG Questionnaire among Patients Referred for Suspected Obstructive Sleep Apnea[J].J Sleep Disord Treat Care,2013,2(4).doi:10.4172/2325-9639.1000121.
[19]潘凤锦,刘建红,谢宇萍,等.广西地区中年打鼾者简单三参数筛查OSAHS的多中心研究[J].中华医学杂志,2015,95(2):100-105.
[20]宋玮,蒋丽君,刘建红,等.颈围对阻塞性睡眠呼吸暂停低通气综合征筛查作用的研究[J].中国临床新医学,2012,5(11):1026-1030.
[2]Da SKV,Garcia RML,Lagoeiro JAJ,et al.Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care[J].Arq Brasil Card,2016,106(6):474-480.
[3]Young T,Evans L,Finn L,et al.Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middleaged men and women[J].Sleep,1997,20(9):705-706.
[4]Pataka A,Daskalopoulou E,Kalamaras G,et al.Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic[J].Sleep Med,2014,15(7):776-781.
[5]杜丽娜,李哲,唐向东.四种量表在阻塞性睡眠呼吸暂停综合征筛查中的应用价值[J].中华医学杂志,2015,95(42):3407-3410.
[6]Silva S,Abeyratne UR,Hukins C.Impact of gender on snorebased obstructive sleep apnea screening[J].Physiol Meas,2012,33(4):587-601.
[7]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.
[8]Friedman M,Tanyeri H,La RM,et al.Clinical predictors of obstructive sleep apnea[J].Laryngoscope,1999,109(12):1901-1907.
[9]Young T,Peppard PE,Gottlieb DJ.Epidemiology of obstructive sleep apnea:a population health perspective[J].Am J Respir Crit Care Med,2002,165(9):1217-1239.
[10]Sean H,Shyam S,Jerry A,et al.Body Mass Index,Gender,and Ethnic Variations Alter the Clinical Implications of the Epworth Sleepiness Scale in Patients with Suspected Obstructive Sleep Apnea[J].Open Respir Med J,2012,6:20-27.
[11]Lim YH,Choi J,Kim KR,et al.Sex-Specific Characteristics of Anthropometry in Patients With Obstructive Sleep Apnea:Neck Circumference and Waist-Hip Ratio[J].Ann Oto Rhinol Laryn,2014,123(7):517-523.
[12]Mohsenin V.Gender differences in the expression of sleepdisordered breathing:role of upper airway dimensions[J].Chest,2001,120(5):1442-1447.
[13]Rowley JA,Sanders CS,Zahn BR,et al.Gender differences in upper airway compliance during NREM sleep:role of neck circumference[J].J Appl Physiol,2002,92(6):2535-2541.
[14]Young T,Finn L,Austin D,et al.Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study[J].Am J Resp Crit Care Med,2003,167(9):1181-1185.
[15]Block AJ,Wynne JW,Boysen PG.Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women[J].Am J Med,1980,69(1):75-79.
[16]Mirer AG,Young T,Palta M,et al.Sleep-disordered breathing and the menopausal transition among participants in the Sleep in Midlife Women Study[J].Menopause(New York,N.Y.),2015,24(2):157-162.
[17]Bixler EO,Vgontzas AN,Lin HM,et al.Prevalence of sleepdisorderd breathing in women:effects of gender[J].Am J Crit Care Med,2001,163(3):608-613.
[18]Boynton G,Vahabzadeh A,Hammoud S,et al.Validation of the STOP-BANG Questionnaire among Patients Referred for Suspected Obstructive Sleep Apnea[J].J Sleep Disord Treat Care,2013,2(4).doi:10.4172/2325-9639.1000121.
[19]潘凤锦,刘建红,谢宇萍,等.广西地区中年打鼾者简单三参数筛查OSAHS的多中心研究[J].中华医学杂志,2015,95(2):100-105.
[20]宋玮,蒋丽君,刘建红,等.颈围对阻塞性睡眠呼吸暂停低通气综合征筛查作用的研究[J].中国临床新医学,2012,5(11):1026-1030.