Medical Research, VA Western New York Healthcare System, Buffalo, NY, 14215-1199, USA.
Clin Res Cardiol. 2012 Sep;101(9):737-44. doi: 10.1007/s00392-012-0453-1. Epub 2012 Apr 3.
To assess the validity of a handheld clinical decision-support system (CDSS) in detecting obstructive sleep apnea (OSA) in veterans with ischemic heart disease against polysomnography (PSG) and to compare the diagnostic accuracy of the CDSS versus the Berlin questionnaire.
We enrolled prospectively 143 patients with underlying ischemic heart disease. Veterans with history of neurologic disease, systolic congestive heart failure, or receiving opiates were excluded from participation. Participants were asked to complete the Berlin Questionnaire and to answer all eight questions of CDSS-software. At the end of the interview, veterans were scheduled for an in-laboratory polysomnogram.
Ninety one patients completed the study. The prevalence of OSA (AHI ≥5/h) was 74.7 % with a median AHI of 11.5/h (range 0-90). When compared to PSG, the CDSS and the Berlin questionnaire achieved a sensitivity of 98.5 % [95 % confidence interval (CI) 92.1-100] and 80.9 % (95 % CI 69.5-89.4) and a specificity of 86.9 % (95 % CI 66.4-97.2) and 39.1 % (95 % CI 19.7-61.5) at a threshold value of AHI ≥5 with a corresponding area under the curve of 0.93 (95 % CI 0.85-0.97) and 0.60 (95 % CI 0.49-0.70); respectively.
CDSS is a superior screening tool for identifying cardiac veterans with undiagnosed OSA than the BQ.
评估手持式临床决策支持系统（CDSS）在检测缺血性心脏病退伍军人阻塞性睡眠呼吸暂停（OSA）方面的有效性，该系统通过多导睡眠图（PSG）进行检测，并比较 CDSS 与柏林问卷的诊断准确性。
我们前瞻性纳入了 143 名患有潜在缺血性心脏病的患者。有神经病史、收缩性充血性心力衰竭或正在服用阿片类药物的退伍军人被排除在研究之外。要求参与者完成柏林问卷并回答 CDSS 软件的所有 8 个问题。访谈结束后，退伍军人被安排进行实验室多导睡眠图检查。
91 名患者完成了研究。OSA（AHI≥5/h）的患病率为 74.7%，中位 AHI 为 11.5/h（范围 0-90）。与 PSG 相比，CDSS 和柏林问卷的敏感性分别为 98.5%（95%置信区间 92.1-100）和 80.9%（95%置信区间 69.5-89.4），特异性分别为 86.9%（95%置信区间 66.4-97.2）和 39.1%（95%置信区间 19.7-61.5），当 AHI≥5 的阈值时，相应的曲线下面积分别为 0.93（95%置信区间 0.85-0.97）和 0.60（95%置信区间 0.49-0.70）。
与 BQ 相比，CDSS 是一种更好的筛查工具，可用于识别未诊断的 OSA 心脏退伍军人。
