Division of Sleep Medicine, Sanford Health and Sanford Research, Fargo, ND, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Arizona College of Medicine, Banner University Medical Center, Tucson, AZ, USA.
Trauma Research, Sanford Health, Fargo, ND, USA.
Sleep Med. 2020 Aug;72:157-163. doi: 10.1016/j.sleep.2020.03.027. Epub 2020 Apr 3.
Screening for obstructive sleep apnea (OSA) in both inpatient and outpatient settings to pursue diagnostic testing is becoming increasingly relevant, particularly given the estimates of 85-90% of patients with OSA remaining undiagnosed. Although many questionnaires are available for OSA screening, the STOP-BANG questionnaire is becoming increasingly used due to ease of use and positive performance characteristics. The utility of nocturnal oximetry, in conjunction with standard questionnaire-based strategies to enhance OSA screening in adults, has yet to be systematically examined.
To evaluate the utility of nocturnal oximetry measures combined with the standard STOP-BANG questionnaire as a screening strategy for OSA in the hospital setting and outpatient clinics.
We conducted a retrospective cohort study. We reviewed the electronic medical records of 130 patients who were referred to Sanford sleep center from both inpatient and outpatient settings over one year (August 1st, 2016 to August 1st, 2017). Nocturnal oximetry was conducted at home (in the outpatient group) and in the medical wards (in the inpatient group), and the following measures were obtained: Oxygen Desaturation Index (ODI), mean SaO2 and time spent below 88% SaO2 (T88). Apnea-hypopnea index (AHI), mean SaO2, and T88 from overnight polysomnography (PSG) and STOP-BANG score.
Based upon likelihood ratio testing comparing discriminative ability, a model of (ODI + STOPBANG) was superior and more accurate than STOP-BANG alone in detecting mild OSA in the overall sample (AUC = 0.644 [0.549-0.739], p = 0.003) and inpatient sample (AUC = 0.710 [0.582-0.839], p = 0.001). This approach was also more accurate in detecting severe OSA in full sample (AUC = 0.839 [0.763-0.914], p < 0.0001), inpatient sample (AUC = 0.825 [0.711-0.939], p < 0.0001) and outpatient sample (AUC = 0.827 [0.699-0.955], p < 0.0001). The ODI alone was more accurate than STOP-BANG alone in detecting mild OSA in the overall sample (AUC = 0.620 [0.524-0.717], p = 0.014) and inpatient sample (AUC = 0.704 [0.574-0.835], p = 0.002) and severe OSA in full sample (AUC = 0.839 [0.764-0.915], p < 0.0001), inpatient sample (AUC = 0.827 [0.714-0.940], p < 0.0001) and outpatient sample (AUC = 0.861 [0.771-0.950], p < 0.0001).
The use of nocturnal oximetry measures (ODI) improved the accuracy of standard OSA screening with the STOP-BANG questionnaire as a screening tool in severe OSA in both inpatient and outpatient settings.
Obstructive sleep apnea is a common sleep disorder that impacts many co-morbidities in different age groups. Enhancing affordable screening methods for OSA can facilitate early diagnosis and treatment and subsequently ameliorate morbidity and mortality related to sleep-disordered breathing.
在住院和门诊环境中筛查阻塞性睡眠呼吸暂停（OSA）以进行诊断性测试变得越来越重要，尤其是考虑到约 85-90%的 OSA 患者仍未被诊断出来。虽然有许多问卷可用于 OSA 筛查，但由于使用方便和阳性性能特征，STOP-BANG 问卷的使用越来越多。在成年人中，结合基于标准问卷的策略使用夜间血氧饱和度监测来增强 OSA 筛查的效用尚未得到系统评估。
评估夜间血氧饱和度测量值与标准 STOP-BANG 问卷结合作为住院和门诊环境中 OSA 的筛查策略的效用。
我们进行了一项回顾性队列研究。我们回顾了 2016 年 8 月 1 日至 2017 年 8 月 1 日期间从住院和门诊转介到 Sanford 睡眠中心的 130 名患者的电子病历。夜间血氧饱和度在门诊组进行家庭监测，在住院组进行医疗病房监测，并获得以下指标：氧减指数（ODI）、平均 SaO2 和低于 88%SaO2 的时间（T88）。过夜多导睡眠图（PSG）和 STOP-BANG 评分的呼吸暂停低通气指数（AHI）、平均 SaO2 和 T88。
基于比较鉴别能力的似然比检验，模型（ODI+STOPBANG）在检测总体样本（AUC=0.644 [0.549-0.739]，p=0.003）和住院样本（AUC=0.710 [0.582-0.839]，p=0.001）中轻度 OSA 的检测中优于单独使用 STOP-BANG，更准确。这种方法在全样本（AUC=0.839 [0.763-0.914]，p<0.0001）、住院样本（AUC=0.825 [0.711-0.939]，p<0.0001）和门诊样本（AUC=0.827 [0.699-0.955]，p<0.0001）中检测重度 OSA 也更准确。ODI 单独用于检测全样本（AUC=0.620 [0.524-0.717]，p=0.014）和住院样本（AUC=0.704 [0.574-0.835]，p=0.002）中的轻度 OSA，以及全样本（AUC=0.839 [0.764-0.915]，p<0.0001）和住院样本（AUC=0.827 [0.714-0.940]，p<0.0001）和门诊样本（AUC=0.861 [0.771-0.950]，p<0.0001）中的重度 OSA，比单独使用 STOP-BANG 更准确。
在严重 OSA 中，使用夜间血氧饱和度测量（ODI）可提高标准 OSA 筛查与 STOP-BANG 问卷作为筛查工具的准确性，无论是在住院和门诊环境中。
阻塞性睡眠呼吸暂停是一种常见的睡眠障碍，影响不同年龄组的许多合并症。增强 OSA 的负担得起的筛查方法可以促进早期诊断和治疗，从而改善与睡眠呼吸障碍相关的发病率和死亡率。
