肺功能影响 Berlin 问卷、改良 Berlin 问卷和 STOP-Bang 评分在 COPD 患者中筛查阻塞性睡眠呼吸暂停的性能。
Pulmonary Function Influences the Performance of Berlin Questionnaire, Modified Berlin Questionnaire, and STOP-Bang Score for Screening Obstructive Sleep Apnea in Subjects with Chronic Obstructive Pulmonary Disease.
机构信息
Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Clinical Centre for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2020 May 29;15:1207-1216. doi: 10.2147/COPD.S248139. eCollection 2020.
PURPOSE
The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) has been described as the overlap syndrome. The objective of the study is to investigate the performance of Berlin Questionnaire (BQ), modified Berlin Questionnaire (MBQ), and STOP-Bang score in screening overlap syndrome from COPD subjects and investigate how pulmonary function interferes with questionnaire scoring.
SUBJECTS AND METHODS
Among 116 COPD subjects included in this study, 62 were overlap syndrome subjects and 54 were COPD subjects without OSA. Subjects included were asked to fill out the questionnaires to collect demographic characteristics of subjects and questionnaire scores of BQ, MBQ, and STOP-Bang; perform pulmonary function test to confirm their COPD diagnosis; and perform polysomnography.
RESULTS
AUC (area under the curve) of BQ, MBQ, and STOP-Bang score in screening OSA among patients with COPD was 0.71 (0.64-0.79), 0.75 (0.67-0.83), and 0.72 (0.64-0.80). In COPD subjects without OSA, FEV1%pred was statistically associated with the misdiagnosis of BQ (P= 0.0091), MBQ (P= 0.0143), and STOP-Bang (P= 0.0453). In patients with overlap syndrome, FVC%pred affected the risk of misdiagnosis of the three questionnaires (BQ: P= 0.0413; MBQ: P= 0.0150; STOP-Bang: P= 0.0241). BMI and neck circumferences (NC) were negatively correlated with FEV1%pred (BMI: P= 0.0454; NC: P= 0.0230) and FVC%pred (BMI: P= 0.0042; NC: P= 0.0367) in overlap subjects. In contrast, BMI was positively correlated with FEV1/FVC (P= 0.0141) and FEV1%pred (P= 0.0391) in COPD subjects without OSA.
CONCLUSION
BQ, MBQ, and STOP-Bang score performed well in COPD subjects for screening OSA. The diagnosis of the three questionnaires was more accurate in subjects with lower FEV1%pred or FVC%pred value. Pulmonary function might exert influence on the diagnosis efficacy of the three questionnaires through BMI and neck circumference.
目的
慢性阻塞性肺疾病（COPD）和阻塞性睡眠呼吸暂停（OSA）共存被描述为重叠综合征。本研究的目的是调查柏林问卷（BQ）、改良柏林问卷（MBQ）和 STOP-Bang 评分在 COPD 患者中筛查重叠综合征的表现，并探讨肺功能如何影响问卷评分。
方法
本研究纳入了 116 例 COPD 患者，其中 62 例为重叠综合征患者，54 例为无 OSA 的 COPD 患者。要求患者填写问卷以收集患者的人口统计学特征和 BQ、MBQ 和 STOP-Bang 的问卷评分；进行肺功能检查以确认 COPD 诊断；并进行多导睡眠图检查。
结果
在 COPD 患者中，BQ、MBQ 和 STOP-Bang 评分筛查 OSA 的 AUC（曲线下面积）分别为 0.71（0.64-0.79）、0.75（0.67-0.83）和 0.72（0.64-0.80）。在无 OSA 的 COPD 患者中，FEV1%pred 与 BQ（P=0.0091）、MBQ（P=0.0143）和 STOP-Bang（P=0.0453）的误诊显著相关。在重叠综合征患者中，FVC%pred 影响了三个问卷的误诊风险（BQ：P=0.0413；MBQ：P=0.0150；STOP-Bang：P=0.0241）。BMI 和颈围（NC）与 FEV1%pred（BMI：P=0.0454；NC：P=0.0230）和 FVC%pred（BMI：P=0.0042；NC：P=0.0367）呈负相关。相比之下，BMI 与 FEV1/FVC（P=0.0141）和 FEV1%pred（P=0.0391）在无 OSA 的 COPD 患者中呈正相关。
结论
BQ、MBQ 和 STOP-Bang 评分在 COPD 患者中筛查 OSA 表现良好。在 FEV1%pred 或 FVC%pred 值较低的患者中，三种问卷的诊断准确性更高。肺功能可能通过 BMI 和颈围对三种问卷的诊断效果产生影响。
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