护士主导的人体测量和口咽测量联合 STOP-Bang 问卷在急性冠状动脉综合征患者阻塞性睡眠呼吸暂停筛查中的价值：一项前瞻性队列研究。

The value of nurse-led anthropometric and oropharyngeal measurements combined with STOP-Bang questionnaire in screening for obstructive sleep apnea in patients with acute coronary syndrome: a prospective cohort study.

机构信息

Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.

National Clinical Research Center for Cardiovascular Diseases, Beijing, China.

出版信息

BMC Pulm Med. 2022 Nov 3;22(1):396. doi: 10.1186/s12890-022-02200-x.

DOI:10.1186/s12890-022-02200-x

PMID:36329414

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9632106/

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) is a modifiable risk factor for acute coronary syndrome (ACS), with high prevalence but low diagnostic rates. Therefore, it is particularly important to develop strategies for better screening for OSA in newly admitted ACS patients.

METHODS

From March 2017 to October 2019, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. All anthropometric and oropharyngeal parameters are measured by specialist nurses.

RESULTS

Finally, 761 ACS patients were recruited in the present study. Prevalence of moderate/severe OSA was 53.2% based on diagnostic criteria of AHI ≥ 15. Correlation analysis illustrated that AHI was positively correlated with anthropometric characteristics. In the multivariate model, only micrognathia (OR 2.02, 95% CI 1.02-4.00, P = 0.044), waist circumference (OR 1.08, 95% CI 1.04-1.11, P < 0.001), and STOP-BANG Questionnaire (SBQ) score (OR 1.45, 95% CI 1.27-1.66, P < 0.001) were independently associated with the prevalence of OSA. Receiver operating characteristic curve (ROC) analysis showed that the area under curve (AUC) of multivariable joint diagnosis (waist circumference, micrognathia combined with SBQ) was significantly better than the AUC of Epworth Sleepiness Scale (ESS) and SBQ (p < 0.0001 and p = 0.0002, respectively), and the results showed that AUC was 0.728. Under the optimal truncation value, the sensitivity was 73%, and the specificity was 61%, which was higher than the single index. Finally, we also constructed a nomogram model based on multiple logistic regression, to easily determine the probability of OSA in ACS patients.

CONCLUSIONS

The new screening tool has greater power than single questionnaire or measurements in screening of OSA among ACS patients.

TRIAL REGISTRATION

Clinicaltrials.gov identifier NCT03362385, registered December 5, 2017.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）是急性冠状动脉综合征（ACS）的可修正风险因素，其患病率高，但诊断率低。因此，开发针对新入院 ACS 患者的 OSA 更好筛查策略尤为重要。

方法

2017 年 3 月至 2019 年 10 月，连续纳入符合条件的 ACS 患者在住院期间接受心肺多导睡眠图检查。OSA 定义为呼吸暂停低通气指数（AHI）≥15 次/小时。所有人体测量学和口咽部参数均由专科护士测量。

结果

本研究最终纳入 761 例 ACS 患者。根据 AHI≥15 的诊断标准，中重度 OSA 的患病率为 53.2%。相关性分析表明，AHI 与人体测量学特征呈正相关。在多变量模型中，只有小下颌（OR 2.02，95%CI 1.02-4.00，P=0.044）、腰围（OR 1.08，95%CI 1.04-1.11，P<0.001）和 STOP-BANG 问卷（SBQ）评分（OR 1.45，95%CI 1.27-1.66，P<0.001）与 OSA 的患病率独立相关。受试者工作特征曲线（ROC）分析显示，多变量联合诊断（腰围、小下颌与 SBQ）的曲线下面积（AUC）明显优于 Epworth 嗜睡量表（ESS）和 SBQ（p<0.0001 和 p=0.0002），AUC 为 0.728。在最佳截断值下，灵敏度为 73%，特异性为 61%，均高于单一指标。最后，我们还基于多变量逻辑回归构建了一个列线图模型，以方便确定 ACS 患者 OSA 的概率。