Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain.
Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Sleep Med. 2019 May;57:15-20. doi: 10.1016/j.sleep.2019.01.033. Epub 2019 Feb 8.
A close relationship between obstructive sleep apnoea (OSA) and Alzheimer's disease (AD) has been described in recent years. OSA is a risk factor for AD, but the diagnosis and clinical characteristics of OSA in patients with AD is not well understood. This study evaluated the clinical utility of two screening questionnaires, the STOP-Bang questionnaire (SBQ) and the Berlin questionnaire (BQ), to identify which patients with mild AD are at higher risk of having OSA and to determine the clinical predictors of OSA in this population.
In this study, 91 consecutive outpatients with mild AD were prospectively evaluated with the SBQ and the BQ. All patients underwent level 1 in-laboratory polysomnography. The predictive performance of the questionnaires were calculated for different apnoea-hypopnoea index (AHI) cut-offs.
The median age of the patients was 76.0 (73.0; 80.0) years, and 58 (63.7%) were female. Of those, 81 patients (89.02%) were found to have OSA defined by an AHI > 5 events/h. Comparing the predictive performances of the SBQ and the BQ, the SBQ was found to have a higher diagnostic sensitivity (85% vs 4%), a lower specificity (35% vs. 96%), a higher positive predictive value (PPV) (44% vs 33%) and negative predictive value (NPV) (80% vs 65%) for detecting severe OSA at an AHI cut-off of 30 events/h. None of the items alone in the two questionnaires predicted the risk of OSA. A modified version of the SBQ, with new cut-off points for several variables according to the characteristics of AD patients, showed a slightly greater AUC than the standard SBQ (AUC 0.61 vs 0.72).
There is a high prevalence of OSA among patients with mild AD. The SBQ and the BQ are not good screening tools for detecting OSA in patients with AD. A modified version of SBQ could increase the detection of these patients.
近年来，阻塞性睡眠呼吸暂停（OSA）与阿尔茨海默病（AD）之间存在密切关系。OSA 是 AD 的一个危险因素，但 AD 患者的 OSA 诊断和临床特征尚不清楚。本研究评估了两种筛查问卷，即 STOP-Bang 问卷（SBQ）和柏林问卷（BQ）的临床实用性，以确定哪些轻度 AD 患者有更高的患 OSA 风险，并确定该人群中 OSA 的临床预测因素。
本研究前瞻性评估了 91 例连续的轻度 AD 门诊患者的 SBQ 和 BQ。所有患者均进行了 1 级实验室多导睡眠图检查。为不同的呼吸暂停低通气指数（AHI）截断值计算了问卷的预测性能。
患者的中位年龄为 76.0（73.0；80.0）岁，58 例（63.7%）为女性。其中 81 例（89.02%）患者的 AHI>5 次/小时，被诊断为 OSA。与 SBQ 和 BQ 的预测性能相比，SBQ 的诊断灵敏度更高（85%比 4%），特异性更低（35%比 96%），阳性预测值（PPV）更高（44%比 33%），阴性预测值（NPV）更高（80%比 65%），用于检测 AHI 截断值为 30 次/小时的严重 OSA。两个问卷中的任何一个项目都不能单独预测 OSA 的风险。根据 AD 患者的特点，对几个变量的 SBQ 进行了修改，并设定了新的截断点，其 AUC 略大于标准 SBQ（AUC 0.61 比 0.72）。
轻度 AD 患者中 OSA 的患病率很高。SBQ 和 BQ 不是检测 AD 患者 OSA 的良好筛查工具。SBQ 的改良版本可以增加对这些患者的检测。
