老年阻塞性睡眠呼吸暂停低通气综合征患者严重程度列线图预测模型的建立

Establishment of a nomogram prediction model for the severity of elderly patients with obstructive sleep apnea hypopnea syndrome

目的 探讨老年阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者严重程度的影响因素,并建立老年患者OSAHS中重度风险的列线图预测模型。方法 收集2016年1月—2020年12月在新疆医科大学某附属医院确诊的1 244例老年OSAHS患者的一般资料和临床资料,用睡眠呼吸暂停低通气指数(apnea hypopnea index, AHI)测定OSAHS的严重程度,采用二元logistic回归分析老年患者OSAHS中重度的影响因素,并建立预测中重度OSAHS风险的列线图模型。结果 1 244例老年OSAHS患者中轻度(5次/h≤AHI≤15次/h)、中度(16次/h≤AHI≤30次/h)、重度(AHI>30次/h)分别为40.11%、35.85%、24.04%;二元logistic回归分析结果显示,肥胖、年龄在75~80岁、颈围、肌酐、糖化血红蛋白是老年OSAHS患者病情为中重度的影响因素。基于影响中重度OSAHS风险建立的列线图模型,列线图模型联合预测因子预测老年人中重度OSAHS风险的受试者工作特征曲线(receiver operating characteristic curve, ROC)下面积为0.655[95%CI(0.624~0.687)],高于单因子ROC曲线下面积,且列线图模型联合预测因子预测老年人群中重度OSAHS的校正曲线趋近于理想曲线,说明模型具有较好的预测效果。结论 肥胖、年龄在75~80岁、颈围、肌酐、糖化血红蛋白为老年患者OSAHS中重度影响因素,根据这些因素建立的列线图有助于预测中重度OSAHS风险较大的老年人群。

Objective To investigate the factors influencing the severity of elderly patients with obstructive sleep apnea hypopnea syndrome( OSAHS),and to establish a nomogram prediction model for moderate and severe risk of OSAHS in elderly patients.Methods We collected the general and clinical data of 1,244 elderly patients with OSAHS diagnosed in an Affiliated Hospital of Xinjiang Medical University from January 2016 to December 2020. The severity of OSAHS was measured by apnea hypopnea index( AHI). The factors influencing moderate and severe OSAHS in elderly patients were analyzed by binary logistic regression,and a nomogram model for predicting the risk of moderate and severe OSAHS was established. Results Among the 1,244 elderly patients with OSAHS,mild OSAHS( 5 times/h≤AHI≤15 times/h),moderate OSAHS( 16 times/h≤AHI≤30 times/h) and severe OSAHS( AHI > 30 times/h) were 40. 11%,35. 85% and 24. 04%,respectively. The results of binary logistic regression analysis displayed that obesity,75-80 years of age,neck circumference,creatinine and glycosylated hemoglobin were the influencing factors of moderate and severe conditions in the elderly patients with OSAHS. The nomogram model was established based on the risk of moderate-severe OSAHS. The area under the receiver operating characteristic( ROC) curve of the joint predictors of the nomogram model for predicting the risk of moderate and severe OSAHS in the elderly was 0.655( 95%CI: 0.624-0.687),which was higher than the area under the single factor ROC curve. The correction curve of the joint predictors of the nomogram model for predicting the risk of moderate and severe OSAHS in the elderly was close to the ideal curve,indicating that the model had good prediction effect. Conclusion Obesity,75-80 years of age,neck circumference,creatinine and glycosylated hemoglobin are the influencing factors of moderate and severe OSAHS in the elderly,and the nomogram established based on these factors is conducive to predicting the elderly population at high risk of moderate and severe OSAHS.