Liang Dong, Gong Zhengpeng, Yu Ming, Wang Rong
Department of Otolaryngology Head and Neck Surgery，Affiliated Hospital of Guizhou Medical University，Guiyang，550004，China.
Department of Otolaryngology Head and Neck Surgery，Baiyun Hospital Affiliated to Guizhou Medical University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Aug;35(8):733-740. doi: 10.13201/j.issn.2096-7993.2021.08.013.
To assess the accuracy of the STOP-Bang questionnaire（SBQ） about screening for obstructive sleep apnea（OSA） in adults, and to establish appropriate cutoffs for body mass index（BMI）, neck circumference（NC）, age, and SBQ score for this population in combination with the body size characteristics of the study subjects, and to evaluate the accuracy of the SBQ for combined screening with waist to height ratio（WHtR）. The data were collected from October, 2019 to November, 2020 at the Affiliated Hospital of Guizhou Medical University, and 218 patients with suspicious OSA were included in this study, all of them completed the SBQ and underwent overnight PSG. SBQ screening and PSG were tested in a blinded concurrent manner. Using the PSG results as the gold standard, the subjects were divided into a diseased group with moderate to severe OSA and a non-diseased group based on apnea hypopnea index. According to SBQ screening results, the subjects were divided into a positive group with moderate severe OSA and negative group. And calculated in the form of four-fold table, the optimal cutoffs were determined by adjusting age, BMI, NC, and SBQ score cutoffs, and calculating the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV）, Youden index, and area under the receiver operating characteristic curve（ROC）. And the modified version of SBQ was combined with WHtR for joint diagnosis to evaluate the accuracy of combined screening. With all 218 patients completing the experiment, 159（72.94%） patients were in the moderate-severe group. The original SBQ had a sensitivity of 93.71%, specificity of 47.46%, PPV of 82.80%, NPV of 73.70%, Youden index of 0.41, and area under the ROC curve（AUC） of 0.71 for predicting moderate to severe OSA. When adjusting the BMI cutoff to 30 kg/m², NC cutoff to 40 cm, and age cutoff to 50 years, the modified SBQ had a sensitivity of 95.60%, specificity of 47.46%, PPV of 83.10%, NPV of 80.00%, Youden index of 0.43, and AUC of 0.72 for predicting moderate to severe OSA. When the modified SBQ score was 4 or more as the cutoff value, the highest Youden index and AUC were 0.54, 0.77 respectively. When the modified SBQ≥3 points were combined with WHtR>0.55, the highest Youden index and AUC were 0.58, 0.79 respectively. SBQ is effective in screening for moderate to severe OSA and better screening accuracy can be achieved by using a modified version of the SBQ（BMI>30 kg/m², NC>40 cm, age>50 years）. The maximum diagnostic accuracy can be achieved when the modified SBQ total score was 4 or more as the cutoff. Those with the modified SBQ total score=3 and WHtR>0.55 can be classified as high risk for moderate to severe OSA, and the modified version of SBQ can be a screening tool to identify moderate to severe OSA.
为评估STOP-Bang问卷（SBQ）对成人阻塞性睡眠呼吸暂停（OSA）筛查的准确性，结合研究对象的体型特征，确定该人群体重指数（BMI）、颈围（NC）、年龄及SBQ评分的合适截断值，并评估SBQ与腰高比（WHtR）联合筛查的准确性。数据于2019年10月至2020年11月在贵州医科大学附属医院收集，本研究纳入218例疑似OSA患者，所有患者均完成SBQ并接受整夜多导睡眠图（PSG）检查。SBQ筛查和PSG以盲法同步进行。以PSG结果作为金标准，根据呼吸暂停低通气指数将受试者分为中重度OSA疾病组和非疾病组。根据SBQ筛查结果，将受试者分为中重度OSA阳性组和阴性组。并以四格表形式计算，通过调整年龄、BMI、NC和SBQ评分截断值，计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、约登指数及受试者工作特征曲线（ROC）下面积，确定最佳截断值。将修改版SBQ与WHtR联合诊断，评估联合筛查的准确性。218例患者均完成实验，159例（72.94%）患者为中重度组。原始SBQ预测中重度OSA的敏感性为93.71%，特异性为47.46%，PPV为82.80%，NPV为73.70%，约登指数为0.41，ROC曲线下面积（AUC）为0.71。当将BMI截断值调整为30kg/m²、NC截断值调整为40cm、年龄截断值调整为50岁时，修改版SBQ预测中重度OSA的敏感性为95.60%，特异性为47.46%，PPV为83.10%，NPV为80.00%，约登指数为0.43，AUC为0.72。以修改版SBQ评分≥4分为截断值时，约登指数和AUC最高，分别为0.54、0.77。当修改版SBQ≥3分与WHtR>0.55联合时，约登指数和AUC最高，分别为0.58、0.79。SBQ对中重度OSA筛查有效，使用修改版SBQ（BMI>30kg/m²，NC>40cm，年龄>50岁）可获得更好的筛查准确性。以修改版SBQ总分≥4分为截断值时可达到最大诊断准确性。修改版SBQ总分=3且WHtR>0.55者可分类为中重度OSA高危人群，修改版SBQ可作为识别中重度OSA的筛查工具。
