STOP-BANG问卷在高血压人群筛查重度睡眠呼吸暂停综合征的适用性评价及改良

Applicability and improvement of STOP-BANG questionnaire in screening for severe OSA in hypertension patients

目的评估STOP-BANG问卷针对高血压合并重度睡眠呼吸暂停综合征(OSA)人群的预测效能,以及在STOP-BANG问卷中建立更合适该人群的BMI及颈围截断值。方法收集2018—2019年于新疆自治区人民医院高血压科住院的高血压疑似OSA患者342例,进行7 h的夜间多导睡眠监测(PSG),完成STOPBANG问卷。评估STOP-BANG问卷预测重度OSA准确性,并评价针对该人群重新设定截断值的改良STOP-BANG问卷的适用性。结果共284例患者完成试验,原始STOP-BANG问卷对高血压重度OSA人群预测的敏感度和特异度分别为80.58%和60.69%,ROC曲线下面积为0.755(P<0.001)。改良问卷中当体质量指数(BMI)与颈围截断值分别改变为28 kg/m2与42 cm时,曲线下面积为0.81(0.76~0.85),此时改良问卷敏感度87.77%(81.1%~92.7%),特异度为62.07%(53.6%~70.0%),约登指数为0.50。结论STOPBANG问卷对筛查该人群具有较高的敏感度和中度的准确性,建议该改良问卷使用BMI>28 kg/m2,颈围>42 cm,STOP-BANG评分≥3为截断值识别高血压重度OSA高风险患者。

Objective To evaluate the predictive efficacy of the STOP-BANG questionnaire for patients with hypertension and severe sleep apnea syndrome(OSA),and to establish a more suitable boday mass index(BMI)and neck circumference cutoff value for this population in the STOP-BANG questionnaire.Methods Hypertensive patients with suspected OSA hospitalized in the Hypertension Department of the People’s Hospital of Xinjiang Autonomous Region from 2018 to 2019 were collected.The 7-hour night polysomnography(PSG)and the STOP-BANG questionaire were conducted.The accuracy of the STOP-BANG questionnaire to predict severe OSA was assessed,and the applicability of the modified STOP-BANG questionnaire to reset the cut-off value for this population was observed.Results A total of 284 patients completed the trial.The sensitivity and specificity of the original STOP-BANG questionnaire for severe OSA was 80.58%and 60.69%,respectively,and the area under the ROC curve was 0.755(P<0.001).In the modified questionnaire,when the cut-off value of BMI was changed to 28 kg/m^2 and the cut-off value of neck circumference was change to 42 cm,the area under the curve was 0.81(0.76-0.85).The sensitivity and specificity of the modified questionnaire for severe OSA was 87.77%(81.1%-92.7%)and 62.07%(53.6%-70.0%),respectively,and the Youden index was 0.50.Conclusion The STOP-BANG questionnaire has high sensitivity and moderate accuracy for screening severe OSA in patients with hypertention.It is recommended that the modified questionnaire with BMI>28 kg/m2,neck circumference>42 cm,and STOP-BANG score≥3 has better predictive efficacy for this population.