Department Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Australia.
Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia.
J Clin Sleep Med. 2018 Dec 15;14(12):2057-2064. doi: 10.5664/jcsm.7536.
Sleep apnea is associated with adverse health outcomes. Despite being an important comorbidity in obesity, type 2 diabetes, heart failure, and resistant hypertension, it is underdiagnosed in these patient groups. An inexpensive and readily accessible sleep apnea screening tool would help address this problem. We sought to compare three commonly used screening tools.
We recruited 812 patients who had not previously been investigated for sleep apnea from our institution's diabetes (n = 512), obesity (n = 129), resistant hypertension (n = 74) and heart failure (n = 43) clinics. Patients completed three frequently used sleep apnea screening questionnaires (STOP-BANG, Berlin, and OSA50). A total of 758 patients had a valid (> 4 hours' duration) level 3 home sleep study. Studies were reported by a sleep physician and were deemed positive if they recorded a respiratory event index (REI) ≥ 15 events/h.
The 758 patients with valid sleep studies were age 59 ± 11 years and 63% were male. A total of 38% of patients had a positive test. The respective sensitivities and specificities of the screening questionnaires at the recommended screening thresholds (REI ≥ 15 events/h) were STOP-BANG ≥ 3 (95% and 19%), STOP-BANG ≥ 5 (60% and 69%), Berlin (75% and 38%), and OSA50 (88% and 21%). We identified six independent predictors (age, sex, body mass index, neck circumference, snoring ≥ 3 days per week, observed apnea ≥ 3 days per week). However, combining these factors was no better than the STOP-BANG in predicting sleep apnea. All patients with a STOP-BANG < 3 had an REI < 30 events/h.
There is a high prevalence of undiagnosed symptomatic sleep apnea in high-risk patient groups. The STOP-BANG questionnaire appeared superior, though all questionnaires had significant limitations. Incorporation of STOP-BANG ≥ 3 in this high-risk population might reduce the need for sleep testing in a resource-constrained setting.
睡眠呼吸暂停与不良健康结果相关。尽管它是肥胖、2 型糖尿病、心力衰竭和难治性高血压的重要合并症，但在这些患者群体中，它的诊断率较低。一种廉价且易于获得的睡眠呼吸暂停筛查工具将有助于解决这个问题。我们试图比较三种常用的筛查工具。
我们招募了 812 名从未接受过睡眠呼吸暂停检查的患者，这些患者分别来自我们机构的糖尿病（n = 512）、肥胖症（n = 129）、难治性高血压（n = 74）和心力衰竭（n = 43）诊所。患者完成了三种常用的睡眠呼吸暂停筛查问卷（STOP-BANG、柏林和 OSA50）。共有 758 名患者进行了有效的（持续时间超过 4 小时）三级家庭睡眠研究。研究由一名睡眠医生报告，如果记录的呼吸事件指数（REI）≥ 15 次/小时，则被认为是阳性。
758 名进行了有效睡眠研究的患者年龄为 59 ± 11 岁，63%为男性。共有 38%的患者测试结果为阳性。在推荐的筛查阈值（REI ≥ 15 次/小时）下，筛查问卷的灵敏度和特异性分别为 STOP-BANG ≥ 3（95%和 19%）、STOP-BANG ≥ 5（60%和 69%）、柏林（75%和 38%）和 OSA50（88%和 21%）。我们确定了六个独立的预测因素（年龄、性别、体重指数、颈围、每周打鼾≥3 天、每周观察到的呼吸暂停≥3 天）。然而，将这些因素结合起来并不能比 STOP-BANG 更好地预测睡眠呼吸暂停。所有 STOP-BANG<3 的患者的 REI<30 次/小时。
在高危患者群体中，未诊断的有症状睡眠呼吸暂停的患病率很高。STOP-BANG 问卷似乎更优越，尽管所有问卷都有显著的局限性。在资源有限的情况下，将 STOP-BANG≥3 纳入这一高危人群可能会减少对睡眠测试的需求。
