Lam Aaron, D'Rozario Angela L, Kong Shawn, Ireland Catriona, Mowszowski Loren, LaMonica Haley M, Phillips Craig L, Hoyos Camilla M, Grunstein Ronald R, Naismith Sharon L
Healthy Brain Ageing Program, The Brain and Mind Centre, University of Sydney, Australia.
School of Psychology, Faculty of Science, University of Sydney, Australia.
J Alzheimers Dis. 2025 Jan;103(1):218-229. doi: 10.1177/13872877241299458. Epub 2024 Nov 29.
Obstructive sleep apnea (OSA) is highly prevalent among older adults and has been associated with cognitive decline and dementia risk. The suitability of screening tools for detecting OSA in memory clinic settings is unclear.
To evaluate the utility and validity of the STOP-Bang questionnaire (SBQ) and pulse oximeter as a screening tool, compared to gold-standard polysomnography (PSG) in older adults attending a memory clinic.
Participants aged over 50 with new onset cognitive/mood concerns attended a memory clinic, then completed the SBQ, oximetry, and PSG. The SBQ and oximetry's accuracy in detecting moderate-severe and severe OSA was evaluated using receiver operating curves. Intraclass correlation and Bland-Altman plots compared the oximeter's adjusted oxygen desaturation index (ODI-Ox) and PSG's apnea-hypopnea index (AHI-PSG).
Of 194 participants (mean age = 65.6, 64 males) who completed PSG, 184 completed the SBQ, and 138 completed oximetry. SBQ demonstrated limited performance for moderate-severe OSA (sensitivity = 52%, specificity = 62%, AUC = 0.600) and severe OSA (sensitivity = 18%, specificity = 87%, AUC = 0.577). Oximetry was satisfactory for moderate-severe OSA (sensitivity = 67%, specificity = 73%, AUC = 0.769) and severe OSA (sensitivity = 50%, specificity = 88%, AUC = 0.730). The diagnostic performance was improved with new cut-offs at ODI-Ox ≥ 11 for AHI-PSG ≥ 15 and ODI-Ox ≥ 20 for AHI-PSG ≥ 30. Bland-Altman plots and intraclass correlation indicated acceptable agreement for oximetry.
The findings suggest that while the SBQ may be unsuitable to detect moderate or severe OSA for older adults with cognitive impairment, oximetry may be a viable screening tool. Given OSA treatment can optimize sleep and may slow cognitive decline, routine screening for OSA should be part of memory clinic assessments.
阻塞性睡眠呼吸暂停（OSA）在老年人中非常普遍，并且与认知能力下降和痴呆风险相关。在记忆门诊环境中，用于检测OSA的筛查工具的适用性尚不清楚。
与金标准多导睡眠图（PSG）相比，评估STOP-Bang问卷（SBQ）和脉搏血氧仪作为筛查工具在就诊于记忆门诊的老年人中的实用性和有效性。
年龄超过50岁且有新发认知/情绪问题的参与者就诊于记忆门诊，然后完成SBQ、血氧测定和PSG。使用受试者工作曲线评估SBQ和血氧测定在检测中度至重度和重度OSA方面的准确性。组内相关性和Bland-Altman图比较了血氧仪的调整后氧去饱和指数（ODI-Ox）和PSG的呼吸暂停低通气指数（AHI-PSG）。
在完成PSG的194名参与者（平均年龄 = 65.6岁，64名男性）中，184名完成了SBQ，138名完成了血氧测定。SBQ在检测中度至重度OSA（敏感性 = 52%，特异性 = 62%，AUC = 0.600）和重度OSA（敏感性 = 18%，特异性 = 87%，AUC = 0.577）方面表现有限。血氧测定在检测中度至重度OSA（敏感性 = 67%，特异性 = 73%，AUC = 0.769）和重度OSA（敏感性 = 50%，特异性 = 88%，AUC = 0.730）方面令人满意。对于AHI-PSG≥15，ODI-Ox≥11以及对于AHI-PSG≥30，ODI-Ox≥20的新临界值可提高诊断性能。Bland-Altman图和组内相关性表明血氧测定具有可接受的一致性。
研究结果表明，虽然SBQ可能不适用于检测患有认知障碍的老年人的中度或重度OSA，但血氧测定可能是一种可行的筛查工具。鉴于OSA治疗可以优化睡眠并可能减缓认知能力下降，OSA的常规筛查应成为记忆门诊评估的一部分。
