Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, South Australia 5041, Australia.
Thorax. 2011 Mar;66(3):213-9. doi: 10.1136/thx.2010.152801. Epub 2011 Jan 20.
To address the growing burden of disease and long waiting lists for sleep services, a simplified two-stage model was developed and validated for identifying obstructive sleep apnoea (OSA) in primary care using a screening questionnaire followed by home sleep monitoring.
157 patients aged 25-70 years attending their primary care physician for any reason at six primary care clinics in rural and metropolitan regions of South Australia participated. The first 79 patients formed the development group and the next 78 patients the validation group. A screening questionnaire was developed from factors identified from sleep surveys, demographic and anthropometric data to be predictive of moderate to severe OSA. Receiver operating characteristic (ROC) curve analysis was used to validate the two-channel ApneaLink device against full polysomnography. The diagnostic accuracy of the overall two-stage model was then evaluated.
Snoring, waist circumference, witnessed apnoeas and age were predictive of OSA and incorporated into a screening questionnaire (ROC area under curve (AUC) 0.84, 95% CI 0.75 to 0.94, p<0.001). ApneaLink oximetry with a 3% dip rate was highly predictive of OSA (AUC 0.96, 95% CI 0.91 to 1.0, p<0.001). The two-stage diagnostic model showed a sensitivity of 0.97 (95% CI 0.81 to 1.00) and specificity of 0.87 (95% CI 0.74 to 0.95) in the development group, and a sensitivity of 0.88 (95% CI 0.60 to 0.98) and specificity of 0.82 (95% CI 0.70 to 0.90) in the validation group.
A two-stage model of screening questionnaire followed by home oximetry can accurately identify patients with OSA in primary care and has the potential to expedite care for patients with this common sleep disorder.
为了应对日益增长的疾病负担和睡眠服务的长时间等待名单，开发并验证了一种简化的两阶段模型，用于通过使用筛查问卷识别初级保健中的阻塞性睡眠呼吸暂停（OSA），然后进行家庭睡眠监测。
157 名年龄在 25-70 岁的患者 岁在南澳大利亚农村和城市地区的六家初级保健诊所因任何原因就诊其初级保健医生。前 79 名患者组成发展组，下 78 名患者组成验证组。从睡眠调查、人口统计学和人体测量学数据中确定的因素制定了一个筛查问卷，以预测中重度 OSA。使用接收器工作特性（ROC）曲线分析验证双通道 ApneaLink 设备与全多导睡眠图的相关性。然后评估整体两阶段模型的诊断准确性。
打鼾、腰围、目击呼吸暂停和年龄是 OSA 的预测因素，并纳入筛查问卷（ROC 曲线下面积（AUC）0.84，95%CI 0.75 至 0.94，p<0.001）。ApneaLink 血氧仪的 3%下降率高度预测 OSA（AUC 0.96，95%CI 0.91 至 1.0，p<0.001）。在发展组中，两阶段诊断模型的敏感性为 0.97（95%CI 0.81 至 1.00），特异性为 0.87（95%CI 0.74 至 0.95），在验证组中，敏感性为 0.88（95%CI 0.60 至 0.98），特异性为 0.82（95%CI 0.70 至 0.90）。
筛查问卷后进行家庭血氧监测的两阶段模型可以准确识别初级保健中的 OSA 患者，并有潜力为患有这种常见睡眠障碍的患者提供快速治疗。
