筛查问卷对不同临床队列中成人阻塞性睡眠呼吸暂停的诊断准确性：系统评价和荟萃分析。

Diagnostic accuracy of screening questionnaires for obstructive sleep apnoea in adults in different clinical cohorts: a systematic review and meta-analysis.

机构信息

Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.

Community Health Services, Leicestershire Partnership NHS Trust, Leicester, UK.

出版信息

Sleep Breath. 2022 Sep;26(3):1053-1078. doi: 10.1007/s11325-021-02450-9. Epub 2021 Aug 18.

PURPOSE

The majority of individuals with clinically significant obstructive sleep apnoea (OSA) are undiagnosed and untreated. A simple screening tool may support risk stratification, identification, and appropriate management of at-risk patients. Therefore, this systematic review and meta-analysis evaluated and compared the accuracy and clinical utility of existing screening questionnaires for identifying OSA in different clinical cohorts.

METHODS

We conducted a systematic review and meta-analysis of observational studies assessing the diagnostic value of OSA screening questionnaires. We identified prospective studies, validated against polysomnography, and published to December 2020 from online databases. To pool the results, we used random effects bivariate binomial meta-analysis.

RESULTS

We included 38 studies across three clinical cohorts in the meta-analysis. In the sleep clinic cohort, the Berlin questionnaire's pooled sensitivity for apnoea-hypopnoea index (AHI) ≥ 5, ≥ 15, and ≥ 30 was 85%, 84%, and 89%, and pooled specificity was 43%, 30%, and 33%, respectively. The STOP questionnaire's pooled sensitivity for AHI ≥ 5, ≥ 15, and ≥ 30 was 90%, 90%, and 95%, and pooled specificity was 31%, 29%, and 21%. The pooled sensitivity of the STOP-Bang questionnaire for AHI ≥ 5, ≥ 15, and ≥ 30 was 92%, 95%, and 96%, and pooled specificity was 35%, 27%, and 28%. In the surgical cohort (AHI ≥ 15), the Berlin and STOP-Bang questionnaires' pooled sensitivity were 76% and 90% and pooled specificity 47% and 27%.

CONCLUSION

Among the identified questionnaires, the STOP-Bang questionnaire had the highest sensitivity to detect OSA but lacked specificity. Subgroup analysis considering other at-risk populations was not possible. Our observations are limited by the low certainty level in available data.

目的

大多数有临床意义的阻塞性睡眠呼吸暂停（OSA）患者未被诊断和治疗。简单的筛查工具可能有助于对高危患者进行风险分层、识别和适当管理。因此，本系统评价和荟萃分析评估和比较了用于识别不同临床队列中 OSA 的现有筛查问卷的准确性和临床实用性。

方法

我们对评估 OSA 筛查问卷诊断价值的观察性研究进行了系统评价和荟萃分析。我们从在线数据库中确定了前瞻性研究，这些研究经过多导睡眠图验证，并于 2020 年 12 月前发表。为了汇总结果，我们使用了随机效应双变量二项式荟萃分析。

结果

我们将荟萃分析纳入了三个临床队列中的 38 项研究。在睡眠诊所队列中，柏林问卷对呼吸暂停低通气指数（AHI）≥5、≥15 和≥30 的综合敏感性分别为 85%、84%和 89%，综合特异性分别为 43%、30%和 33%。STOP 问卷对 AHI≥5、≥15 和≥30 的综合敏感性分别为 90%、90%和 95%，综合特异性分别为 31%、29%和 21%。STOP-Bang 问卷对 AHI≥5、≥15 和≥30 的综合敏感性分别为 92%、95%和 96%，综合特异性分别为 35%、27%和 28%。在手术队列（AHI≥15）中，柏林问卷和 STOP-Bang 问卷的综合敏感性分别为 76%和 90%，综合特异性分别为 47%和 27%。