Hoffstein V, Szalai J P
Department of Medicine, St. Michael's Hospital, Toronto, Canada.
Sleep. 1993 Feb;16(2):118-22.
We examined the predictive value of history and physical examination in the diagnosis of obstructive sleep apnea (OSA) syndrome. This was achieved by studying a set of 594 patients referred to the sleep clinic because of suspicion of sleep apnea. All patients were asked a set of standard sleep-related questions and all had nocturnal polysomnography. We used stepwise multiple linear regression analysis to examine the relationship between the apnea/hypopnea index (AHI), defined as the number of episodes of cessation of breathing per hour of sleep (dependent variable), and age, sex, body mass index (BMI) and replies to the sleep questionnaire (independent variables). We found that age, sex, body mass index, bed partner observation of apnea and pharyngeal examination were significant predictors of AHI, explaining 36% of the variability. Subjective impression of the examining clinician was also an independent significant predictor of AHI, accounting for 10% of the variability. Using a conventional cutoff value of 10 to divide patients into apneics (AHI > 10) and nonapneics (AHI < or = 10), the sensitivity of subjective impression was 60% and the specificity 63%. We conclude that although clinical features obtained during history and physical examination explain a relatively high percent of the variability in AHI, subjective clinical impression alone is not sufficient to reliably identify patients with or without sleep apnea.
我们研究了病史和体格检查在阻塞性睡眠呼吸暂停（OSA）综合征诊断中的预测价值。这是通过研究一组因怀疑睡眠呼吸暂停而被转诊至睡眠诊所的594例患者来实现的。所有患者均被问及一系列与睡眠相关的标准问题，并均接受了夜间多导睡眠图检查。我们使用逐步多元线性回归分析来研究呼吸暂停/低通气指数（AHI）（定义为每小时睡眠时间内呼吸停止发作次数，为因变量）与年龄、性别、体重指数（BMI）以及睡眠问卷回答（自变量）之间的关系。我们发现，年龄、性别、体重指数、床伴对呼吸暂停的观察以及咽部检查是AHI的显著预测因素，可解释36%的变异性。检查医生的主观印象也是AHI的一个独立显著预测因素，占变异性的10%。使用传统的临界值10将患者分为呼吸暂停患者（AHI>10）和非呼吸暂停患者（AHI<或=10），主观印象的敏感性为60%，特异性为63%。我们得出结论，尽管病史和体格检查中获得的临床特征可解释AHI中相对较高比例的变异性，但仅凭主观临床印象不足以可靠地识别有无睡眠呼吸暂停的患者。
