Mihaicuta Stefan, Udrescu Lucreţia, Udrescu Mihai, Toth Izabella-Anita, Topîrceanu Alexandru, Pleavă Roxana, Ardelean Carmen
Department of Pulmonology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, 300041 Timişoara, Romania.
CardioPrevent Foundation, 3 Calea Dorobanţilor, 300134 Timişoara, Romania.
Diagnostics (Basel). 2021 Jan 7;11(1):86. doi: 10.3390/diagnostics11010086.
We explored the relationship between obstructive sleep apnea (OSA) patients' anthropometric measures and the CPAP treatment response. To that end, we processed three non-overlapping cohorts (D1, D2, D3) with 1046 patients from four sleep laboratories in Western Romania, including 145 subjects (D1) with one-night CPAP therapy. Using D1 data, we created a CPAP-response network of patients, and found neck circumference (NC) as the most significant qualitative indicator for apnea-hypopnea index (AHI) improvement. We also investigated a quantitative NC cutoff value for OSA screening on cohorts D2 (OSA-diagnosed) and D3 (control), using the area under the curve. As such, we confirmed the correlation between NC and AHI (ρ=0.35, p<0.001) and showed that 71% of diagnosed male subjects had bigger NC values than subjects with no OSA (area under the curve is 0.71, with 95% CI 0.63-0.79, p<0.001); the optimal NC cutoff is 41 cm, with a sensitivity of 0.8099, a specificity of 0.5185, positive predicted value (PPV) = 0.9588, negative predicted value (NPV) = 0.1647, and positive likelihood ratio (LR+) = 1.68. Our NC =41 cm threshold classified the D1 patients' CPAP responses-measured as the difference in AHI prior to and after the one-night use of CPAP-with a sensitivity of 0.913 and a specificity of 0.859.
我们探讨了阻塞性睡眠呼吸暂停（OSA）患者的人体测量指标与持续气道正压通气（CPAP）治疗反应之间的关系。为此，我们对来自罗马尼亚西部四个睡眠实验室的1046例患者进行了三个不重叠的队列研究（D1、D2、D3），其中包括145例接受了一晚CPAP治疗的受试者（D1）。利用D1的数据，我们创建了患者的CPAP反应网络，并发现颈围（NC）是呼吸暂停低通气指数（AHI）改善的最显著定性指标。我们还使用曲线下面积研究了队列D2（已诊断为OSA）和D3（对照组）中用于OSA筛查的NC定量临界值。由此，我们证实了NC与AHI之间的相关性（ρ=0.35，p<0.001），并表明71%已诊断的男性受试者的NC值大于无OSA的受试者（曲线下面积为0.71，95%置信区间为0.63 - 0.79，p<0.001）；最佳NC临界值为41 cm，灵敏度为0.8099，特异度为0.5185，阳性预测值（PPV）=0.9588，阴性预测值（NPV）=0.1647，阳性似然比（LR+）=1.68。我们的NC = 41 cm阈值对D1患者的CPAP反应进行了分类，该反应以一晚使用CPAP前后AHI的差异来衡量，灵敏度为0.913，特异度为0.859。
