A modified STOP-Bang questionnaire for OSA screening in the young, middle-age women
-
摘要: 目的 评价改良STOP-Bang(MS-B)量表对中青年女性阻塞性睡眠呼吸暂停(OSA)患者的筛查能力。方法 回顾性分析523例疑似OSA中青年女性患者，对其进行S-B量表和MS-B量表评分，并进行整夜PSG监测。MS-B量表BMI和颈围(NC)值是通过ROC曲线最佳工作点(OOP)来确定。应用ROC曲线和配对资料卡方检验对2个量表进行评估。结果 MS-B量表中BMI设定为28 kg/m2，NC为36 cm。当AHI分别设为≥5次/h、≥15次/h、≥30次/h时，MS-B较S-B量表有更高的敏感度(88.7% vs 86.7%，92.8% vs 87.7%，95.0% vs 90.1%)和曲线下面积(0.74 vs 0.706，0.734 vs 0.703，0.739 vs 0.699)。配对资料卡方检验显示差异有统计学意义(P < 0.05)。结论 将BMI和NC分别调整为28 kg/m2和36 cm后，可能有利于提高S-B量表在OSA中青年女性患者中的筛查能力。
-
关键词:
- 睡眠呼吸暂停, 阻塞性 /
- STOP-Bang评分量表 /
- 女性 /
- BMI /
- 颈围
Abstract: Objective The STOP-Bang(S-B) questionnaire is widely used for screening patients with OSA. However, BMI and NC cutoff value in the original S-B questionnaire is 35 kg/m2and 40cm, the BMI and NC value in the young and middle-aged female patients in China is lower than that. We aimed to establish a more appropriate modified STOP-Bang(MS-B) questionnaire.Method A total of 523 cases with suspected OSA in the young and middle-aged female were included in this study. All patients were asked to completed the S-B, MS-B questionnaire and undergo overnight polysomnography(PSG). The BMI and NC value of the MS-B were determined by the optimal operating points of the ROC. The ability of S-B and MS-B were assessed by ROC and McNemar's test.Result BMI=28 kg/m2and NC=36 cm as alternative cutoff is to refine S-B questionnaire. When taking apnea hypopnea index(AHI) ≥5 times/h, ≥15 times/h and ≥30 times/h as cut-offs, MS-B had higher sensitivity(88.7% vs 86.7%, 92.8% vs 87.7%, 95.0% vs 90.1%, respectively) and the area under the curve(0.74 vs 0.706, 0.734 vs 0.703, 0.739 vs 0.699, respectively) than S-B. There were significant differences in McNemar test(P < 0.05).Conclusion This study examined the clinical utility of MS-B. MS-B may improve predictive performance of S-B questionnaire in the young and middle-aged female with OSA.-
Key words:
- sleep apnea, obstructive /
- STOP-Bang questionnaire /
- women /
- BMI /
- neck circumference
-
-
表 1 研究对象的基本信息
x±s 指标 非OSA组
(n=162)OSA组
(n=361)P值 年龄/岁 43.38±12.78 51.20±9.97 < 0.05 NC/cm 34.16±2.49 36.31±3.29 < 0.05 BMI/(kg·m-2) 24.16±4.10 27.28±4.43 < 0.05 
下载: 导出CSV
表 2 不同BMI和NC截点下的S-B量表预测特性
项目 不同BMI(kg/m2)和NC(cm)组合 BMI>35、NC>40 BMI≥30、NC>40 BMI≥28、NC>40 BMI≥30、NC≥36 BMI≥28、NC≥36 S-B评分≥3 高危人数(%) 395(75.5) 407(77.8) 413(79.0) 420(80.3) 423(80.9) AHI ≥5次/h AUC 0.706 0.726 0.739 0.732 0.740 约登指数 0.314 0.359 0.395 0.377 0.400 AHI ≥15次/h AUC 0.703 0.719 0.725 0.732 0.734 约登指数 0.326 0.364 0.375 0.396 0.403 AHI≥30次/h AUC 0.694 0.711 0.717 0.738 0.739 约登指数 0.316 0.356 0.376 0.402 0.403
下载: 导出CSV
表 3 不同AHI截点下S-B和MS-B量表的预测指标
AHI 量表 敏感度 特异度 阳性预测值 阴性预测值 ≥5次/h S-B 83.1(78.7~86.7) 41.4(33.8~49.4) 75.9(71.4~80.0) 52.3(43.4~61.2) MS-B 88.6(84.6~91.6) 36.4(29.1~44.4) 75.6(71.2~79.6) 59.0(48.7~68.6) ≥15次/h S-B 87.7(82.6~91.4) 34.4(29.0~40.2) 52.2(47.1~57.2) 77.3(68.9-84.1) MS-B 92.8(88.5~95.6) 28.8(23.7~34.5) 51.5(46.7~56.4) 83.0(73.9~89.5) ≥30次/h S-B 90.1(83.6~94.3) 29.8(25.4~34.7) 32.2(27.6~37.0) 89.1(82.0~93.7) MS-B 95.0(89.7~97.8) 24.3(20.2~29.0) 31.7(27.3~36.4) 93.0(85.6~96.9)
下载: 导出CSV
-
[1] 中华医学会呼吸病学分会呼吸障碍学组. 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. doi: 10.3760/cma.j.issn.1001-0939.2012.01.007
[2] 陈曦, 李进让, 孙建军. 阻塞性睡眠呼吸暂停低通气综合征对心血管疾病的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2012, 26(16): 733-736. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201216007.htm
[3] Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea[J]. Anesthesiology, 2008, 108(5): 812-821. doi: 10.1097/ALN.0b013e31816d83e4
[4] Duarte R, Fonseca L, Magalhães-da-Silveira FJ, et al. Validation of the STOP-Bang questionnaire as a means of screening for obstructive sleep apnea in adults in Brazil[J]. J Bras Pneumol, 2017, 43(6): 456-463. doi: 10.1590/s1806-37562017000000139
[5] Rebelo-Marques A, Vicente C, Valentim B, et al. STOP-Bang questionnaire: the validation of a Portuguese version as a screening tool for obstructive sleep apnea(OSA)in primary care[J]. Sleep Breath, 2018, 22(3): 757-765. doi: 10.1007/s11325-017-1608-0
[6] Hu YY, Yu Y, Wang ZB, et al. Reliability and Validity of Simplified Chinese STOP-BANG Questionnaire in Diagnosing and Screening Obstructive Sleep Apnea Hypopnea Syndrome[J]. Curr Med Sci, 2019, 39(1): 127-133. doi: 10.1007/s11596-019-2010-x
[7] 余洋, 梅伟, 崔永华. S-B评分量表对OSAHS预测作用的初步评价[J]. 临床耳鼻咽喉头颈外科杂志, 2012, 26(6): 256-259. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201206006.htm
[8] Pavarangkul T, Jungtrakul T, Chaobangprom P, et al. The Stop-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea-Induced Hypertension in Asian Population[J]. Neurol Int, 2016, 8(1): 6104.
[9] Yagi H, Nakata S, Tsuge H, et al. Morphological examination of upper airway in obstructive sleep apnea[J]. Auris Nasus Larynx, 2009, 36(4): 444-449. doi: 10.1016/j.anl.2008.11.003
[10] Xia M, Liu S, Ji N, et al. BMI 35 kg/m2 does not fit everyone: a modified STOP-Bang questionnaire for sleep apnea screening in the Chinese population[J]. Sleep Breath, 2018, 22(4): 1075-1082. doi: 10.1007/s11325-017-1610-6
[11] Mou J, Pflugeisen BM, Crick BA, et al. The discriminative power of STOP-Bang as a screening tool for suspected obstructive sleep apnea in clinically referred patients: considering gender differences[J]. Sleep Breath, 2019, 23(1): 65-75. doi: 10.1007/s11325-018-1658-y
[12] Nagappa M, Liao P, Wong J, et al. Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis[J]. PLoS One, 2015, 10(12): e0143697. doi: 10.1371/journal.pone.0143697
[13] Basoglu OK, Tasbakan MS. Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients[J]. Sleep Breath, 2018, 22(1): 241-249. doi: 10.1007/s11325-017-1482-9
[14] Appleton S, Gill T, Taylor A, et al. Influence of Gender on Associations of Obstructive Sleep Apnea Symptoms with Chronic Conditions and Quality of Life[J]. Int J Environ Res Public Health, 2018, 15(5): 930. doi: 10.3390/ijerph15050930
-