Jonassen Trygve M, Bjorvatn Bjørn, Saxvig Ingvild W, Eagan Tomas Ml, Lehmann Sverre
Centre for Sleep Medicine, Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Centre for Sleep Medicine, Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
Respir Med. 2022 Jun;197:106860. doi: 10.1016/j.rmed.2022.106860. Epub 2022 Apr 26.
Obstructive sleep apnea (OSA) is highly prevalent with serious health consequences. Demand for diagnostic studies is high, in many countries exceeding capacity.
The objective of this cross-sectional study was to identify predictors of severe OSA among patients on waiting lists for sleep studies, to better prioritize time to examinations.
The sample comprised 3646 patients (30.3% women) referred to a university clinic in Western Norway with suspected OSA. All patients underwent respiratory polygraphy. Severe OSA was defined by an apnea-hypopnea index ≥30. Information on symptoms (snoring, breathing cessations, daytime sleepiness) and medical history was collected with questionnaires, including prior diagnosis of angina, myocardial infarction, stroke, hypertension, depression or diabetes. Blood pressure was measured with thresholds of 90 and 140 mmHg defining diastolic and systolic hypertension.
15.7% had severe OSA. In multivariate logistic regression analysis, factors positively associated with severe OSA were increasing age, male sex, snoring, breathing cessations, BMI ≥30, diastolic hypertension, self-reported history of hypertension, and self-reported myocardial infarction. A prediction score (range 0-5) devised from 5 of these items (age ≥50, snoring, breathing cessations, BMI ≥30, and self-reported hypertension) had a sensitivity of 96.2% and a negative predictive value of 97.1% for severe OSA, when a score ≥2 was set as cut-off.
Based on a prediction score derived from simple, easily available data, patients unlikely to suffer from severe OSA can be identified, and thus facilitate more urgent consideration of patients more likely to have severe OSA.
阻塞性睡眠呼吸暂停（OSA）非常普遍，会导致严重的健康后果。诊断研究的需求很高，在许多国家已超出了现有能力。
这项横断面研究的目的是确定睡眠研究等待名单上的患者中重度OSA的预测因素，以便更好地确定检查时间的优先级。
样本包括3646名转诊至挪威西部一家大学诊所的疑似OSA患者（女性占30.3%）。所有患者均接受了呼吸多导睡眠监测。重度OSA定义为呼吸暂停低通气指数≥30。通过问卷收集有关症状（打鼾、呼吸暂停、日间嗜睡）和病史的信息，包括既往心绞痛、心肌梗死、中风、高血压、抑郁症或糖尿病的诊断。测量血压，舒张压和收缩压高血压的阈值分别为90和140 mmHg。
15.7%的患者患有重度OSA。在多因素逻辑回归分析中，与重度OSA呈正相关的因素包括年龄增加、男性、打鼾、呼吸暂停、BMI≥30、舒张期高血压、自我报告的高血压病史和自我报告的心肌梗死病史。根据其中5项指标（年龄≥50岁、打鼾、呼吸暂停、BMI≥30和自我报告的高血压）设计的预测评分（范围0-5），当评分≥2作为临界值时，对重度OSA的敏感性为96.2%，阴性预测值为97.1%。
基于从简单、容易获得的数据得出的预测评分，可以识别出不太可能患有重度OSA的患者，从而有助于更迫切地考虑更可能患有重度OSA的患者。
