Smiesko Milan, Jenigarova Ester, Stanko Peter, Kasa Zsolt, Cavarga Ivan, Lassan Stefan
Department of Pneumology, Phthisiology and Functional Diagnostics, Slovak Medical University and Bratislava University Hospital, 82606 Bratislava, Slovakia.
Institute of Pathophysiology, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia.
Diseases. 2024 Dec 14;12(12):330. doi: 10.3390/diseases12120330.
Obstructive sleep apnea syndrome (OSAS) is a frequently underdiagnosed sleep disorder marked by recurrent episodes of apnea and/or hypopnea during sleep, primarily resulting from the partial or complete collapse of the upper airway. OSAS significantly affects patients' health and quality of life. Additionally, it is a recognized risk factor for inducing microsleep episodes during daily activities, particularly in occupations such as professional driving, where sustained attention is critical. The aim of our study was to identify an effective screening test for use in outpatient settings, capable of distinguishing patients with a severe form of OSAS. Patients who test positive with this screening tool would subsequently be prioritized for polysomnographic evaluation in a sleep laboratory. A total of 64 patients who underwent polysomnography (PSG) or polygraphy (PG) examination at our clinic were subsequently examined by USG of the tongue with measurements of tongue base thickness (TBT) and the distance between lingual arteries (DLA) during wakefulness and in a relaxed tongue position. The measurements of TBT and DLA were subsequently correlated with the apnea-hypopnea index (AHI) obtained from PSG or PG. In our cohort of patients diagnosed with severe OSAS, a TBT threshold of ≥65 mm served as an effective cutoff value. A TBT value of ≥65 mm reached an AUC value of 78.1%, sensitivity of 74.4%, specificity of 61.9%, positive predictive value of 80%, negative predictive value of 54.2% and overall accuracy of 70.3%. A DLA value of ≥30 mm in our sample of patients with severe OSAS showed an AUC of 76.5%, sensitivity of 69.8%, specificity of 71.1%, positive predictive value of 83.3%, negative predictive value of 53.6%, and overall accuracy of 70.3%. Tongue USG markers, particularly TBT and DLA measurements during wakefulness and in a relaxed tongue position, show potential as effective screening tools for identifying severe OSAS in European populations. These markers demonstrate improved accuracy over traditional screening questionnaires by reducing the likelihood of false-negative results. Patients with a positive screening should preferably be referred for polysomnography. In this way, patients with a serious illness could receive adequate therapy sooner.
阻塞性睡眠呼吸暂停综合征（OSAS）是一种常被漏诊的睡眠障碍，其特征是睡眠期间反复出现呼吸暂停和/或呼吸不足发作，主要由上呼吸道部分或完全塌陷引起。OSAS严重影响患者的健康和生活质量。此外，它是导致日常活动中微睡眠发作的公认危险因素，尤其是在职业驾驶等职业中，持续注意力至关重要。我们研究的目的是确定一种在门诊环境中有效的筛查测试，能够区分重度OSAS患者。使用这种筛查工具检测呈阳性的患者随后将被优先安排在睡眠实验室进行多导睡眠图评估。共有64例在我们诊所接受多导睡眠图（PSG）或多谱睡眠图（PG）检查的患者，随后在清醒状态下以及舌头放松位置通过超声检查测量舌根厚度（TBT）和舌动脉之间的距离（DLA）。随后将TBT和DLA的测量值与从PSG或PG获得的呼吸暂停低通气指数（AHI）进行相关性分析。在我们诊断为重度OSAS的患者队列中，TBT阈值≥65mm作为有效的临界值。TBT值≥65mm时，曲线下面积（AUC）值为78.1%，敏感性为74.4%，特异性为61.9%，阳性预测值为80%，阴性预测值为54.2%，总体准确率为70.3%。在我们重度OSAS患者样本中，DLA值≥30mm时，AUC为76.5%，敏感性为69.8%，特异性为71.1%，阳性预测值为83.3%，阴性预测值为53.6%，总体准确率为70.3%。舌头超声检查标记物，特别是清醒状态下以及舌头放松位置的TBT和DLA测量值，显示出作为识别欧洲人群中重度OSAS有效筛查工具的潜力。这些标记物通过降低假阴性结果的可能性，比传统筛查问卷具有更高的准确性。筛查呈阳性的患者最好转诊进行多导睡眠图检查。通过这种方式，重病患者可以更快地接受适当治疗。
