Stepney David, Attarian Hrayr P, Knutson Kristen L
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Clin Sleep Med. 2023 Oct 1;19(10):1727-1733. doi: 10.5664/jcsm.10660.
The US Preventive Services Task Force recently released guidelines suggesting little evidence of benefit to screening asymptomatic adults for obstructive sleep apnea (OSA). Our goal was to provide important context to this statement. Specifically, we examined associations between common OSA symptoms, excessive daytime sleepiness and snoring, and OSA severity for different racial/ethnic and sex groups.
Analyses were performed on 2 samples. One combined 2 observational studies that included full polysomnography, the Epworth Sleepiness Scale (ESS), and questions about snoring (mean [standard deviation] age 39 [15.2] years). The second sample was the Multi-Ethnic Study of Atherosclerosis study of older adults (mean [standard deviation] age 69 [9.1] years), which also included polysomnography, ESS and a question about snoring. Apnea-hypopnea index represented OSA severity. For each racial/ethnic-sex group we estimated correlations between apnea-hypopnea index and ESS and the sensitivity and specificity of excessive daytime sleepiness (ESS >10) or frequent snoring to predict moderate-to-severe OSA (apnea-hypopnea index >15 events/h).
A weak significant correlation between OSA severity and ESS was found only in White men in the first sample and Black men in the second sample. Screening tool characteristics for ESS and snoring were poor except for moderate specificity in some racial/ethnic-sex groups.
Excessive daytime sleepiness and snoring are commonly used to identify symptomatic patients. Our results suggest that the accuracy of these symptoms to identify OSA varies by race/ethnicity and sex. Therefore, focus on common symptoms as an OSA screen could systematically leave out certain patient populations who would benefit from treatment.
Stepney D, Attarian HP, Knutson KL. Association between severity of obstructive sleep apnea and its common symptoms varies by race, ethnicity, and sex. . 2023;19(10):1727-1733.
美国预防服务工作组最近发布了指南，表明几乎没有证据显示对无症状成年人进行阻塞性睡眠呼吸暂停（OSA）筛查有益。我们的目标是为这一说法提供重要背景信息。具体而言，我们研究了不同种族/族裔和性别群体中常见的OSA症状、日间过度嗜睡和打鼾与OSA严重程度之间的关联。
对两个样本进行分析。一个样本合并了两项观察性研究，这些研究包括全夜多导睡眠图、爱泼华嗜睡量表（ESS）以及关于打鼾的问题（平均[标准差]年龄为39[15.2]岁）。第二个样本是针对老年人的动脉粥样硬化多族裔研究（平均[标准差]年龄为69[9.1]岁），该研究也包括多导睡眠图、ESS以及一个关于打鼾的问题。呼吸暂停低通气指数代表OSA的严重程度。对于每个种族/族裔 - 性别群体，我们估计了呼吸暂停低通气指数与ESS之间的相关性，以及日间过度嗜睡（ESS>10）或频繁打鼾预测中度至重度OSA（呼吸暂停低通气指数>15次/小时）的敏感性和特异性。
仅在第一个样本中的白人男性和第二个样本中的黑人男性中发现OSA严重程度与ESS之间存在微弱的显著相关性。ESS和打鼾的筛查工具特征较差，除了在某些种族/族裔 - 性别群体中有中等特异性。
日间过度嗜睡和打鼾通常用于识别有症状的患者。我们的结果表明，这些症状识别OSA的准确性因种族/族裔和性别而异。因此，将重点放在常见症状作为OSA筛查手段可能会系统性地遗漏某些能从治疗中获益的患者群体。
斯特普尼D，阿塔里安HP，克努森KL。阻塞性睡眠呼吸暂停严重程度与其常见症状之间的关联因种族、族裔和性别而异。……2023；19(10)：1727 - 1733。
