Martins Emerson Ferreira, Martinez Denis, Cortes Antonio Lasalvia, Nascimento Nicole, Brendler Juliana
Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Cardiology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
J Clin Sleep Med. 2020 Feb 15;16(2):199-206. doi: 10.5664/jcsm.8166. Epub 2020 Jan 13.
The accuracy of obstructive sleep apnea (OSA) screening instruments in seniors may change as the predictive role of sex, age, and body mass index (BMI) changes with aging. We investigated the diagnostic performance of the STOP-BANG questionnaire in older individuals with aging-adapted scores and thresholds.
Independent community-dwelling adults aged 65 years or older were screened for OSA. The STOP-BANG questionnaire was tested with different configurations and compared to the apnea-hypopnea index (AHI) obtained from home sleep apnea testing (HSAT). Epworth Sleepiness Scale (ESS) and Athens Insomnia Scale (AIS) were tested as possible supplementary screening criteria.
We recruited 458 individuals with a mean age of 71 ± 5 years, 41% men, BMI of 28.5 ± 4.6 kg/m². Mild, moderate, and severe OSA were present in, respectively, 34%, 30%, and 19% of the sample. The STOP questions had an area under the curve (AUC) of the receiver operating characteristic curve significantly lower than the STOP-BANG and the STOP+BMI > 28 kg/m² (STOP-B28). Both STOP-BANG and STOP-B28 had high sensitivity and low specificity in all OSA levels with similar AUC to predict AHI ≥ 5 events/h, 0.64. ESS and AIS were nonsignificant as adjunctive instruments.
Novel modifications of a standard instrument created the STOP-B28, a simpler-to-obtain and similarly performing variation of the STOP-BANG using fewer inputs, and useful to exclude OSA. Screening seniors via questionnaires to detect OSA is problematic. Considering the 83% OSA prevalence in this age group, it may be a sensible option to indicate objective tests, oximetry, HSAT, or even polysomnography, as a first step in OSA investigation.
随着性别、年龄和体重指数（BMI）的预测作用随年龄增长而变化，老年人阻塞性睡眠呼吸暂停（OSA）筛查工具的准确性可能会改变。我们研究了采用适应年龄的评分和阈值时，STOP-BANG问卷在老年人中的诊断性能。
对65岁及以上独立居住在社区的成年人进行OSA筛查。采用不同配置对STOP-BANG问卷进行测试，并与家庭睡眠呼吸暂停测试（HSAT）获得的呼吸暂停低通气指数（AHI）进行比较。对爱泼华嗜睡量表（ESS）和雅典失眠量表（AIS）作为可能的补充筛查标准进行测试。
我们招募了458名平均年龄为71±5岁的个体，其中男性占41%，BMI为28.5±4.6kg/m²。样本中轻度、中度和重度OSA的发生率分别为34%、30%和19%。STOP问题在接受者操作特征曲线下的面积（AUC）显著低于STOP-BANG和STOP+BMI>28kg/m²（STOP-B28）。在所有OSA水平上，STOP-BANG和STOP-B28均具有高敏感性和低特异性，预测AHI≥5次/小时的AUC相似，为0.64。ESS和AIS作为辅助工具无显著意义。
对标准工具进行的新修改产生了STOP-B28，这是一种更易于获取且性能相似的STOP-BANG变体，使用的输入更少，有助于排除OSA。通过问卷筛查老年人以检测OSA存在问题。考虑到该年龄组OSA患病率为83%，将客观测试、血氧饱和度测定、HSAT甚至多导睡眠图作为OSA调查的第一步可能是一个明智的选择。
