Lu Huan, Fu Cuiping, Li Wenjing, Jiang Hong, Wu Xiaodan, Li Shanqun
Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
J Thorac Dis. 2017 Jul;9(7):1945-1958. doi: 10.21037/jtd.2017.06.03.
The bidirectional relationship of asthma and obstructive sleep apnea (OSA) has been confirmed in recent years. However, in the clinical practice, majority of asthma patients did not pay adequate attention to their sleep apnea condition. Berlin questionnaire (BQ) and STOP-Bang questionnaire (SBQ) are two most common OSA screening questionnaires to screen high-risk patients for OSA. This study aimed at evaluating the predictive performance of BQ and SBQ for OSA in asthma patients.
Asthma outpatients of Zhongshan Hospital were enrolled into the study. All patients were asked to fill in the BQ and SBQ and clinical characteristics and asthma characteristics were recorded. Univariate and multivariate logistic regression analyses were applied to identify risk factors of OSA in asthma patients. With the gold standard of laboratory-based overnight polysomnography (PSG), the predictive performance of SBQ and BQ was evaluated and compared. The probability of OSA severity was predicted by various SBQ scores in asthma patients.
A total of 123 asthma patients (average age 47.56±12.12 years; 57.72% males) were enrolled and underwent PSG diagnosis overnight at Sleep Center. Logistic regression analyses showed that rhinitis (adjusted OR =4.30; 95% CI: 1.50-12.37, P=0.007) and dyslipidemia (adjusted OR =2.75; 95% CI: 1.16-6.51, P=0.021) were associated with OSA in asthma patients after adjusting for known OSA risk factors. No asthma functional characteristic differences were found to be associated with OSA severity in the study. The prevalence of moderate-to-severe OSA (AHI ≥15) in the asthmatic population sample was 36.59% (45/123). Questionnaires predictive results showed that compared with BQ, SBQ has higher diagnostic sensitivity (84.4% 60%), lower specificity (79.5% 91%) lower positive predictive value (PPV): (70.4% 79.4%) and higher negative predictive value (NPV) (90% 80%) to detect moderate-to-severe OSA at the cut-off as AHI of 15/h. OSA probability results showed that with the increasing of the questionnaire scores, the moderate and severe OSA probability of SBQ rose significantly.
SBQ is a preferable sleep questionnaire better than BQ for detecting moderate and severe OSA in asthma patients which should be validated in larger population sample.
近年来，哮喘与阻塞性睡眠呼吸暂停（OSA）之间的双向关系已得到证实。然而，在临床实践中，大多数哮喘患者并未充分关注其睡眠呼吸暂停状况。柏林问卷（BQ）和STOP-Bang问卷（SBQ）是两种最常用的OSA筛查问卷，用于筛查OSA高危患者。本研究旨在评估BQ和SBQ对哮喘患者OSA的预测性能。
招募中山医院哮喘门诊患者进行研究。所有患者均被要求填写BQ和SBQ，并记录其临床特征和哮喘特征。采用单因素和多因素逻辑回归分析确定哮喘患者OSA的危险因素。以基于实验室的夜间多导睡眠图（PSG）作为金标准，评估并比较SBQ和BQ的预测性能。通过不同的SBQ评分预测哮喘患者OSA严重程度的概率。
共纳入123例哮喘患者（平均年龄47.56±12.12岁；男性占57.72%），并在睡眠中心接受了夜间PSG诊断。逻辑回归分析显示，在调整已知的OSA危险因素后，鼻炎（校正OR =4.30；95%CI：1.50 - 12.37，P =0.007）和血脂异常（校正OR =2.75；95%CI：1.16 - 6.51，P =0.021）与哮喘患者的OSA相关。研究中未发现哮喘功能特征差异与OSA严重程度相关。哮喘人群样本中中重度OSA（呼吸暂停低通气指数[AHI]≥15）的患病率为36.59%（45/123）。问卷预测结果显示，与BQ相比，SBQ在检测AHI为15次/小时的中重度OSA时，具有更高的诊断敏感性（84.4%对60%）、更低的特异性（79.5%对91%）、更低的阳性预测值（PPV）（70.4%对79.4%）和更高的阴性预测值（NPV）（90%对80%）。OSA概率结果显示，随着问卷评分的增加，SBQ的中重度OSA概率显著上升。
对于检测哮喘患者的中重度OSA，SBQ是一种优于BQ的睡眠问卷，但其结果应在更大的人群样本中进行验证。
