Respiratory Specialists, Wyomissing, USA.
J Occup Environ Med. 2013 Sep;55(9):1035-40. doi: 10.1097/JOM.0b013e318298fb0e.
To evaluate joint task force criteria-based screening for severe obstructive sleep apnea (s-OSA) in commercial drivers.
Among a community-based cohort of licensed commercial vehicle drivers, we assessed utility of the joint task force criteria. We conducted full, 14-channel overnight polysomnography in all drivers, defining s-OSA as an apnea-hypopnea index of 30 or more per hour.
One hundred of 104 drivers with successful polysomnography studies were predominantly obese (median body mass index = 32.8 kg/m; interquartile range = 26.8 to 37.4) and had a median apnea-hypopnea index of 20.6 per hour (interquartile range = 10.0 to 34.2). Examination-based criteria were more effective (sensitivity = 80%; negative posttest probability [nPTP] = 17%) than symptom-based criteria (sensitivity = 63%; nPTP = 23%). Examination and symptom-based criteria combined had high sensitivity (97%) and low nPTP (7%), but poor specificity (19%).
Examination-based criteria missed 20% of s-OSA cases. Combining examination with confidentially reported symptoms improved sensitivity but required confirmatory polysomnography in 86%, supporting universal screening of all drivers.
评估联合工作组基于标准的筛选对商业司机严重阻塞性睡眠呼吸暂停（s-OSA）的作用。
在一个基于社区的有执照的商业车辆驾驶员队列中，我们评估了联合工作组标准的实用性。我们对所有驾驶员进行了完整的 14 通道夜间多导睡眠图检查，将 s-OSA 定义为每小时 30 次或更多的呼吸暂停-低通气指数。
在 104 名成功进行多导睡眠图检查的驾驶员中，有 100 名驾驶员主要肥胖（中位数体重指数= 32.8 kg/m；四分位距= 26.8 至 37.4），呼吸暂停-低通气指数中位数为每小时 20.6（四分位距= 10.0 至 34.2）。基于检查的标准比基于症状的标准更有效（敏感性= 80%；阴性后验概率[nPTP] = 17%）。基于检查和症状的标准相结合具有高敏感性（97%）和低 nPTP（7%），但特异性差（19%）。
基于检查的标准遗漏了 20%的 s-OSA 病例。将检查与保密报告的症状相结合可以提高敏感性，但需要对 86%的病例进行确认性多导睡眠图检查，支持对所有驾驶员进行普遍筛查。
