Geriatrics - Unit of Respiratory Pathophysiology - Campus Bio Medico University and Teaching Hospital, Rome - Italy.
J Med Screen. 2013 Dec;20(4):220-6. doi: 10.1177/0969141313511591. Epub 2013 Oct 30.
Polysomnography remains the diagnostic gold standard for obstructive sleep apnea syndrome (OSAS), but it is time consuming and requires dedicated personnel and setting. It may be more useful to plan a polysomnogram based on a preliminary screening.
To verify whether a questionnaire of general quality of sleep, the Pittsburgh Sleep Quality Index (PSQI), could outperform a dedicated questionnaire (Epworth Sleep Scale: ESS) in targeting OSAS patients in an at risk population.
254 consecutive subjects attending the outpatient clinic for respiratory diseases were clinically evaluated for sleep apnea and referred to a 12 channel night-time polysomnography. All patients were administered the ESS and the PSQI before the procedure. The correlation between the Apnoea/Hypopnoea Index (AHI) and the global score of the PSQI was calculated; Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), Diagnostic accuracy and the area under the receiver operating characteristic curve (AUC) were calculated. ESS performance was used as a control reference.
The mean age was 65.8 (standard deviation: 12.1) and the study group was 68.4% male. The mean BMI was 38.5; SD 7.7. Prevalence of OSAS in the study population was 55.5%; OSAS was severe in 60.5% of OSAS patients. ESS was significantly, but weakly, correlated with the AHI (AHI vs ESS: R = 0.308; p < 0.001), whereas PSQI was not (R = 0.037; p = 0.581). Both PSQI and ESS, however, performed unsatisfactorily: sensitivity 37.8% and 69.7%; Specificity 76.1% and 31.0%; Diagnostic Accuracy 57.5% and 49.8%; PPV 60% and 48.7%; NPV 56.3% and 52.2%; AUC 0.589 and 0.509, respectively.
The PSQI score is not helpful in the pre-polysomnographic assessment of people with suspected OSAS. Further studies are required to provide reliable pre-clinical instruments targeting patients amenable to polysomnography.
多导睡眠图仍然是阻塞性睡眠呼吸暂停综合征（OSAS）的诊断金标准，但它耗时且需要专门的人员和设置。根据初步筛查制定多导睡眠图可能会更有用。
验证一般睡眠质量问卷（匹兹堡睡眠质量指数（PSQI））是否优于专用问卷（嗜睡量表：ESS），以针对高危人群中的 OSAS 患者。
254 例连续就诊于呼吸科门诊的患者进行睡眠呼吸暂停的临床评估，并进行 12 通道夜间多导睡眠图检查。所有患者在检查前均进行 ESS 和 PSQI 评分。计算呼吸暂停/低通气指数（AHI）与 PSQI 总分的相关性；计算灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）、诊断准确性和受试者工作特征曲线下面积（AUC）。ESS 表现用作对照参考。
平均年龄为 65.8（标准差：12.1），研究组 68.4%为男性。平均 BMI 为 38.5；SD 为 7.7。研究人群中 OSAS 的患病率为 55.5%；60.5%的 OSAS 患者病情严重。ESS 与 AHI 显著相关，但相关性较弱（AHI 与 ESS：R=0.308；p<0.001），而 PSQI 则没有（R=0.037；p=0.581）。然而，PSQI 和 ESS 的表现都不尽如人意：灵敏度分别为 37.8%和 69.7%；特异性分别为 76.1%和 31.0%；诊断准确性分别为 57.5%和 49.8%；PPV 分别为 60%和 48.7%；NPV 分别为 56.3%和 52.2%；AUC 分别为 0.589 和 0.509。
PSQI 评分无助于疑似 OSAS 患者的多导睡眠图前评估。需要进一步研究以提供针对可进行多导睡眠图检查的患者的可靠临床前工具。
