Ramachandran Satya Krishna, Josephs Lydia A
Department of Anesthesiology, University Hospital, Ann Arbor, Michigan, USA.
Anesthesiology. 2009 Apr;110(4):928-39. doi: 10.1097/ALN.0b013e31819c47b6.
The purpose of this meta-analysis is to compare clinical screening tests for obstructive sleep apnea and establish an evidence base for their preoperative use. Diagnostic odds ratios were used as summary measures of accuracy, and false-negative rates were used as measures of missed diagnosis with each screening test in this review. Metaregression revealed that clinical models, logarithmic equations, combined techniques, cephalometry, and morphometry are significant characteristics, whereas body mass index, history of hypertension, and nocturnal choking are significant test elements associated with higher diagnostic accuracy. Test accuracy in repeated validation studies of the same screening test is variable, suggesting an underlying heterogeneity in either the clinical presentation of obstructive sleep apnea or the measured clinical elements of these models. Based on the false-negative rates, it is likely that most of the clinical screening tests will miss a significant proportion of patients with obstructive sleep apnea.
本荟萃分析的目的是比较阻塞性睡眠呼吸暂停的临床筛查试验，并为其术前使用建立证据基础。诊断比值比用作准确性的汇总指标，假阴性率用作本综述中每项筛查试验漏诊的指标。元回归显示，临床模型、对数方程、联合技术、头影测量和形态测量是显著特征，而体重指数、高血压病史和夜间窒息是与更高诊断准确性相关的显著试验要素。同一筛查试验的重复验证研究中的试验准确性存在差异，这表明阻塞性睡眠呼吸暂停的临床表现或这些模型所测量的临床要素存在潜在异质性。基于假阴性率，很可能大多数临床筛查试验会漏诊相当一部分阻塞性睡眠呼吸暂停患者。
