Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Sleep Breath. 2011 Dec;15(4):819-26. doi: 10.1007/s11325-010-0443-3. Epub 2010 Nov 14.
Obstructive sleep apnea (OSA) remains underdiagnosed, despite our understanding of its impact on general health. Current screening methods utilize either symptoms or physical exam findings suggestive of OSA, but not both. The purpose of this study was to develop a novel screening tool for the detection of OSA, the NAMES assessment (neck circumference, airway classification, comorbidities, Epworth scale, and snoring), combining self-reported historical factors with physical exam findings.
Subjects were adults without previously diagnosed OSA, referred to a community sleep center for suspicion of OSA. General health, Epworth Sleepiness Scale (ESS), and Berlin questionnaires were completed, and a physical exam focusing on modified Friedman (MF) grade, body mass index (BMI), and neck circumference (NC) was performed prior to polysomnography. OSA was defined by a respiratory disturbance index ≥15. Each variable was dichotomized, and cutoff values were determined for the NAMES tool in a pilot group of 150 subjects. The NAMES score was calculated from NC, MF, comorbidities, ESS, and loud snoring values. The performances of the NAMES, Berlin questionnaire, and ESS screening tests in predicting OSA were then compared in a validation group of 509 subjects.
In the pilot population, the cutoff value for the composite NAMES tool was calculated at ≥3 points. In the validation group, NAMES demonstrated similar test characteristics to the Berlin questionnaire, and sensitivity was better than that seen with the Epworth scale. The addition of BMI and gender to the tool improved screening characteristics.
The NAMES assessment is an effective, inexpensive screening strategy for moderate to severe OSA.
尽管我们了解阻塞性睡眠呼吸暂停（OSA）对整体健康的影响，但这种疾病仍未得到充分诊断。目前的筛查方法要么使用症状，要么使用提示 OSA 的体格检查结果，但两者都不使用。本研究的目的是开发一种新的筛查工具来检测 OSA，即 NAMES 评估（颈围、气道分类、合并症、Epworth 量表和打鼾），将自我报告的历史因素与体格检查结果相结合。
研究对象为未经诊断为 OSA 的成年人，因疑似 OSA 而被转介至社区睡眠中心。完成一般健康、Epworth 嗜睡量表（ESS）和柏林问卷，并在进行多导睡眠图检查之前进行侧重于改良 Friedman（MF）分级、体重指数（BMI）和颈围（NC）的体格检查。OSA 的定义为呼吸紊乱指数≥15。对每个变量进行二分类，并在 150 例患者的预试验组中确定 NAMES 工具的截断值。根据 NC、MF、合并症、ESS 和响亮打鼾值计算 NAMES 评分。然后在 509 例验证组中比较 NAMES、柏林问卷和 ESS 筛查试验预测 OSA 的性能。
在预试验人群中，综合 NAMES 工具的截断值计算为≥3 分。在验证组中，NAMES 与柏林问卷具有相似的测试特征，并且敏感性优于 Epworth 量表。将 BMI 和性别添加到工具中可改善筛查特征。
NAMES 评估是一种有效且经济的中重度 OSA 筛查策略。
