Jin Hui, Lee Li-Ang, Song Lijuan, Li Yanmei, Peng Jianxin, Zhong Nanshan, Li Hsueh-Yu, Zhang Xiaowen
Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Otolaryngology, Sleep Center, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
J Clin Sleep Med. 2015 Jul 15;11(7):765-71. doi: 10.5664/jcsm.4856.
Snoring is a common symptom of obstructive sleep apnea syndrome (OSA) and has recently been considered for diagnosis of OSA.
The goal of the current study was to systematically determine the accuracy of acoustic analysis of snoring in the diagnosis of OSA using a meta-analysis.
PubMed, Cochrane Library database, and EMBASE were searched up to July 15, 2014. A systematic review and meta-analysis of sensitivity, specificity, and other measures of accuracy of acoustic analysis of snoring in the diagnosis of OSA were conducted. The median of apneahypopnea index threshold was 10 events/h, range: 5-15 or 10-15 if aforementioned suggestion is adopted.
A total of seven studies with 273 patients were included in the meta-analysis. The pooled estimates were as follows: sensitivity, 88% (95% confidence interval [CI]: 82-93%); specificity, 81% (95% CI: 72-88%); positive likelihood ratio (PLR), 4.44 (95% CI: 2.39-8.27); negative likelihood ratio (NLR), 0.15 (95% CI: 0.10-0.24); and diagnostic odds ratio (DOR), 32.18 (95% CI: 13.96-74.81). χ(2) values of sensitivity, specificity, PLR, NLR, and DOR were 2.37, 10.39, 12.57, 3.79, and 6.91 respectively (All p > 0.05). The area under the summary receiver operating characteristic curve was 0.93. Sensitivity analysis demonstrated that the pooled estimates were stable and reliable. The results of publication bias were not significant (p = 0.30).
Acoustic analysis of snoring is a relatively accurate but not a strong method for diagnosing OSA. There is an urgent need for rigorous studies involving large samples and single snore event tests with an efficacy criterion that reflects the particular features of snoring acoustics for OSA diagnosis.
打鼾是阻塞性睡眠呼吸暂停低通气综合征（OSA）的常见症状，最近已被用于OSA的诊断。
本研究的目的是通过荟萃分析系统地确定打鼾声学分析在OSA诊断中的准确性。
检索截至2014年7月15日的PubMed、Cochrane图书馆数据库和EMBASE。对打鼾声学分析在OSA诊断中的敏感性、特异性和其他准确性指标进行系统评价和荟萃分析。呼吸暂停低通气指数阈值的中位数为10次事件/小时，范围：5 - 15次事件/小时；如果采用上述建议，则范围为1０- 15次事件/小时。
荟萃分析共纳入7项研究，273例患者。汇总估计值如下：敏感性88%（95%置信区间[CI]：82 - 93%）；特异性81%（95%CI：72 - 88%）；阳性似然比（PLR）4.44（95%CI：2.39 - 8.27）；阴性似然比（NLR）0.15（95%CI：0.10 - 0.24）；诊断比值比（DOR）32.18（95%CI：13.96 - 74.81）。敏感性、特异性、PLR、NLR和DOR的χ(2)值分别为2.37、10.39、12.57、3.７9和6.91（所有p > 0.05）。汇总受试者工作特征曲线下面积为0.93。敏感性分析表明汇总估计值稳定可靠。发表偏倚结果不显著（p = 0.30）。
打鼾声学分析是诊断OSA的一种相对准确但不够有力的方法。迫切需要进行严格的大样本研究和单一声鼾事件测试，采用反映OSA诊断鼾声声学特征的疗效标准。
