Department of Medicine, University of Calgary, Alberta, Canada.
J Clin Sleep Med. 2013 Jan 15;9(1):31-8. doi: 10.5664/jcsm.2334.
Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have a high prevalence of obstructive sleep apnea (OSA) that can have significant clinical implications. An accurate clinical screening tool for OSA that identifies patients for further diagnostic testing would assist in the identification of this comorbidity. The Berlin Questionnaire (BQ), Adjusted Neck Circumference (ANC), and STOP-BANG questionnaire are 3 such instruments that have been validated in patients with normal kidney function.
The objective of this study was to determine the validity of these screening instruments in patients with CKD and ESRD, using overnight cardiopulmonary monitoring to diagnose OSA.
One hundred seventy-two patients were recruited from nephrology clinics and hemodialysis units (CKD: n = 109; ESRD: n = 63). All patients completed the BQ, ANC, STOP-BANG, and overnight cardiopulmonary monitoring to diagnose OSA (respiratory disturbance index [RDI] ≥ 15). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for the BQ, ANC, and STOP-BANG.
Obstructive sleep apnea was present in 41 CKD patients (38%) and 32 ESRD patients (51%). All screening instruments had satisfactory sensitivity (56% to 94%) but poor specificity (29% to 77%) and low accuracy (51% to 69%) in both CKD and ESRD patients with RDI ≥ 15. Using an RDI ≥ 30 yielded similar results.
Current screening questionnaires do not accurately identify patients at high risk for OSA or rule out the presence of OSA in patients with CKD and ESRD. Consequently, objective monitoring during sleep is required to reliably identify sleep apnea in these patient populations.
患有慢性肾脏病（CKD）和终末期肾病（ESRD）的患者阻塞性睡眠呼吸暂停（OSA）的患病率很高，这可能具有重要的临床意义。一种准确的临床 OSA 筛查工具，可以识别需要进一步诊断测试的患者，将有助于识别这种合并症。柏林问卷（BQ）、调整颈围（ANC）和 STOP-BANG 问卷是 3 种已在肾功能正常的患者中得到验证的工具。
本研究的目的是确定这些筛查工具在 CKD 和 ESRD 患者中的有效性，使用夜间心肺监测来诊断 OSA。
从肾病诊所和血液透析单位招募了 172 名患者（CKD：n = 109；ESRD：n = 63）。所有患者均完成了 BQ、ANC、STOP-BANG 和夜间心肺监测以诊断 OSA（呼吸紊乱指数[RDI]≥15）。计算了 BQ、ANC 和 STOP-BANG 的敏感性、特异性、阳性和阴性预测值以及准确性。
41 名 CKD 患者（38%）和 32 名 ESRD 患者（51%）存在 OSA。所有筛查工具在 RDI≥15 的 CKD 和 ESRD 患者中均具有令人满意的敏感性（56%至 94%），但特异性（29%至 77%）和准确性（51%至 69%）较差。使用 RDI≥30 得到了类似的结果。
目前的筛查问卷不能准确识别出患有 OSA 高风险的患者，也不能排除 CKD 和 ESRD 患者存在 OSA。因此，需要在睡眠期间进行客观监测，以可靠地识别这些患者群体中的睡眠呼吸暂停。
