用于检测 HIV 感染者中阻塞性睡眠呼吸暂停的筛查工具的诊断性能。
Diagnostic performance of screening tools for the detection of obstructive sleep apnea in people living with HIV.
机构信息
University of California San Diego, La Jolla, California.
出版信息
J Clin Sleep Med. 2022 Jul 1;18(7):1797-1804. doi: 10.5664/jcsm.9964.
STUDY OBJECTIVES
Many people living with human immunodeficiency virus (PLWH) have undiagnosed obstructive sleep apnea (OSA), which may contribute to commonly reported fatigue and the high cardiovascular disease burden in this population. Our objective was to assess the utility of traditional OSA screening tools (STOP-BANG, Berlin Questionnaire, and Epworth Sleepiness Scale) for detecting OSA in PLWH.
METHODS
Adult PLWH were recruited from sleep/ human immunodeficiency virus clinics and the community into a larger clinical trial that included completion of these questionnaires before in-laboratory polysomnography. Discriminatory performance of these screening tools was assessed using area under receiver operating characteristic curves (AUC). The reference standard for the primary analysis was OSA based on an apnea-hypopnea index ≥ 5 events/h using recommended "1A"-criteria (hypopnea with 3% desaturation and/or arousal). Secondary analyses explored acceptable "1B"-criteria (hypopnea with 4% desaturation) and/or higher apnea-hypopnea index cut-offs (≥ 15 events/h).
RESULTS
120 PLWH were included (mean age: 50 ± 11 years; body mass index: 27 ± 4 kg/m, 84% male) and OSA was diagnosed in 75% using 1A-criteria. In the primary analysis, the discriminatory performance of the 3 screening tools was low (AUCs 0.58 to 0.70) and similar across the tools ( ≥ .14). In secondary analyses, STOP-BANG showed moderate-high discriminatory ability (AUCs 0.77-0.80) and performed significantly better ( ≤ .008) than the Berlin Questionnaire or Epworth Sleepiness Scale (AUCs 0.53-0.62).
CONCLUSIONS
OSA was highly prevalent in our cohort of PLWH. Although STOP-BANG could reasonably identify moderate-severe OSA, the tools were not reliable for mild disease. Specifically, the questionnaires perform poorly for PLWH with mild OSA manifesting with arousals, yet such people may be at risk of fatigue/sleepiness and impaired memory consolidation.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Title: Obstructive Sleep Apnea Endotypes and Impact on Phenotypes of People Living with HIV (PLWH/OSA); Identifier: NCT03575143; URL: https://clinicaltrials.gov/ct2/show/NCT03575143.
CITATION
Schmickl CN, Bosompra N-O, DeYoung PN, et al. Diagnostic performance of screening tools for the detection of obstructive sleep apnea in people living with HIV. . 2022;18(7):1797-1804.
研究目的
许多感染人类免疫缺陷病毒（PLWH）的人患有未确诊的阻塞性睡眠呼吸暂停（OSA），这可能导致该人群中常见的疲劳和高心血管疾病负担。我们的目的是评估传统的 OSA 筛查工具（STOP-BANG、柏林问卷和 Epworth 嗜睡量表）在检测 PLWH 中 OSA 的效用。
方法
从睡眠/人类免疫缺陷病毒诊所和社区招募成年 PLWH 参加一项更大的临床试验，该试验包括在实验室多导睡眠图检查前完成这些问卷。使用接受者操作特征曲线下的面积（AUC）评估这些筛查工具的区分性能。主要分析的参考标准是基于推荐的“1A”标准（伴有 3% 血氧饱和度下降和/或觉醒的呼吸暂停）的 OSA，定义为呼吸暂停-低通气指数≥5 次/小时。次要分析探讨了可接受的“1B”标准（伴有 4% 血氧饱和度下降）和/或更高的呼吸暂停-低通气指数截止值（≥15 次/小时）。
结果
共纳入 120 例 PLWH（平均年龄：50±11 岁；体重指数：27±4kg/m，84%为男性），75%的患者根据 1A 标准诊断为 OSA。在主要分析中，3 种筛查工具的区分性能较低（AUC 为 0.58 至 0.70），且工具之间差异无统计学意义（≥0.14）。在次要分析中，STOP-BANG 具有较高的区分能力（AUC 为 0.77-0.80），并且显著优于柏林问卷或 Epworth 嗜睡量表（AUC 为 0.53-0.62）（≤0.008）。
结论
我们队列中的 PLWH 中 OSA 患病率很高。尽管 STOP-BANG 可以合理地识别中重度 OSA，但这些工具对轻度疾病并不可靠。具体来说，这些问卷在表现出觉醒的轻度 OSA 的 PLWH 中表现不佳，但此类人群可能存在疲劳/嗜睡和记忆巩固受损的风险。
临床试验注册
注册处：ClinicalTrials.gov；标题：阻塞性睡眠呼吸暂停的表型和对人类免疫缺陷病毒感染者表型的影响（PLWH/OSA）；标识符：NCT03575143；网址：https://clinicaltrials.gov/ct2/show/NCT03575143。
引用
Schmickl CN、Bosompra N-O、DeYoung PN 等人。用于检测人类免疫缺陷病毒感染者阻塞性睡眠呼吸暂停的筛查工具的诊断性能。. 2022；18（7）：1797-1804。
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