年龄和性别对用于阻塞性睡眠呼吸暂停筛查工具的NoSAS评分表现的影响：一项基于中国医院的回顾性研究
Effects of age and sex on the performance of the NoSAS score as a screening tool for obstructive sleep apnea: a hospital-based retrospective study in China.
作者信息
Zhang Zhigang, Yang Dan, Wang Haiying, Liu Xinmin
机构信息
Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China.
出版信息
Sleep Breath. 2021 Sep;25(3):1407-1417. doi: 10.1007/s11325-020-02254-3. Epub 2020 Nov 21.
OBJECTIVES
The NoSAS score has been shown to be a reliable screening tool for obstructive sleep apnea (OSA) in overall populations. This study aimed to explore the effects of age and sex on the predicting performance of this score.
METHODS
A retrospective analysis was conducted on 1119 subjects aged ≥ 18 years and with a total sleep time of ≥ 4 h during overnight polysomnography. Discrimination was assessed by using areas under receiver operating characteristic curve (AUCs), while predictive parameters were calculated by using contingency tables.
RESULTS
Overall, a NoSAS score of 8 points or higher resulted in sensitivity, specificity, and AUC for predicting an apnea-hypopnea index (AHI) of ≥ 20 events/h of 74%, 36%, and 0.63 (in non-elderly 73%, 46%, and 0.65; in elderly 91%, 17%, and 0.59; in men 85%, 18%, and 0.56; in women 52%, 76%, and 0.71, respectively). The AUCs at all AHI cutoffs were significantly lower in men than in women (all with p < 0.01), while the AUCs at AHI cutoff of 5, 15, and 30 events/h were significantly lower in elderly than in non-elderly (p < 0.01, 0.05, and 0.05, respectively). In non-elderly, a conventional NoSAS with cutoff of 7 or a modified NoSAS with age cutoff of 50 years provided sensitivity and specificity for predicting an AHI of ≥ 20 events/h of 87%, 37% and 80%, 36%, respectively, with comparable AUCs. In women, a conventional NoSAS with cutoff of 6 or a modified NoSAS with neck circumference cutoff of 35 cm provided sensitivity and specificity for predicting an AHI of ≥ 20 events/h of 85%, 39% and 79%, 52%, respectively, with comparable AUCs.
CONCLUSIONS
NoSAS score has better discrimination but lower sensitivity for predicting OSA in non-elderly and women than in their counterparts. Age- and sex-specific cutoff values reverse this imbalance. Our results underline the preference of age- and sex-specific cutoff values and the need for better age- and sex-specific screening algorithms.
目的
NoSAS评分已被证明是总体人群中阻塞性睡眠呼吸暂停（OSA）的可靠筛查工具。本研究旨在探讨年龄和性别对该评分预测性能的影响。
方法
对1119名年龄≥18岁且夜间多导睡眠图总睡眠时间≥4小时的受试者进行回顾性分析。通过使用受试者操作特征曲线下面积（AUC）评估辨别力，同时使用列联表计算预测参数。
结果
总体而言，NoSAS评分8分及以上时，预测呼吸暂停低通气指数（AHI）≥20次/小时的敏感性、特异性和AUC分别为74%、36%和0.63（非老年人中为73%、46%和0.65；老年人中为91%、17%和0.59；男性中为85%、18%和0.56；女性中分别为52%、76%和0.71）。在所有AHI切点处，男性的AUC均显著低于女性（均p<0.01），而在AHI切点为5、15和30次/小时时，老年人的AUC显著低于非老年人（分别为p<0.01、0.05和0.05）。在非老年人中，传统的NoSAS评分切点为7或年龄切点为50岁的改良NoSAS评分预测AHI≥20次/小时的敏感性和特异性分别为87%、37%和80%、36%，AUC相当。在女性中，传统的NoSAS评分切点为6或颈围切点为35 cm的改良NoSAS评分预测AHI≥20次/小时的敏感性和特异性分别为85%、39%和79%、52%，AUC相当。
结论
NoSAS评分在预测非老年人和女性的OSA时辨别力较好但敏感性较低，与其他人群相比存在差异。年龄和性别特异性的切点值可扭转这种不平衡。我们的结果强调了年龄和性别特异性切点值的优势以及需要更好的年龄和性别特异性筛查算法。
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