颈围在心房颤动患者合并阻塞性睡眠呼吸暂停初筛中的意义

Screening value of neck circumference for obstructive sleep apnea in patients with atrial fibrillation.

目的探讨颈围、校正颈围筛查心房颤动（房颤）患者合并阻塞性睡眠呼吸暂停（OSA）的准确性。方法入选行睡眠呼吸监测的房颤患者50例，测量颈围，计算校正颈围[校正颈围（cm）=实际颈围（cm）＋4．0cm（如果患者有高血压）＋3．0cm（如果患者有习惯性打鼾）＋3．0cm（如果患者夜间睡眠有憋气／窒息）]。颈围、校正颈围与OSA严重程度行相关分析，通过受试者工作特征曲线评价颈围、校正颈围诊断OSA的正确性。以睡眠呼吸监测为全标准确定颈围、校正颈围诊断OSA的敏感性和特异性。结果36例（72％）房颤患者有OSA，OSA组颈围显著大于非OSA组[（42．3±3．3）cm与（39．9±2．6）cm，t=2．411，P=0．020]，OSA组校正颈围与非OSA组比较差异有统计学意义[（49．6±4．4）cm与（45．2±4．5）cm，t=3．168．P=0．003]。颈围、校正颈围与OSA严重程度的相关系数分别为0．566、0．629（P均〈0．01）。通过受试者工作特征曲线评价颈围、校正颈围对OSA初筛的评价作用，曲线下面积分别为0．729，0．746，曲线下面积差异无统计学意义（P=0．545）。颈围以41．2cm为界值，诊断OSA的敏感性为74．3％，特异性为71．4％。校正颈围以47．0cm为界值，诊断OSA的敏感性为71．4％，特异性为71．4％。结论颈围、校正颈围与OSA严重程度相关性良好．是房颤患者合并OSA初筛较可靠的指标。

Objective To investigate the screening value of neck circumference （NC） and adjusted neck circumference （ANC） for obstructive sleep apnea （OSA） in patients with atrial fibrillation （AF）. Methods NC and ANC were measured in 50 patients with AF who underwent polysomnography. ANC = NC ＋ 4.0 cm （ if hypertension exists） ＋ 3.0 cm （ if habitual snore exists） ＋ 3.0 cm （ if choke or gasp exists at most night）. Correlation analysis and receiver operating characteristic curve （ROC） were performed to evaluate the accuracy of NC and ANC for screening OSA. Results 36 patients had OSA by polysomnography. The NC and ANC were significantly higher in the OSA group than in the no-OSA group, with the mean value of 42.3 ± 3.3 cm VS 39.9 ± 2.6 cm （ t = 2.411, P = 0,020） and 49.6 ± 4.4 cm VS 45.2 ± 4.5 cm （ t = 3.168, P = 0.003 ）, respectively. NC and ANC were correlated to the severity of OSA with the r values of 0.566（P 〈0.01 ）and 0.629（P 〈0.01 ） ,respectively. There was no significant difference between the area under the ROC of NC and ANC （0. 729 VS 0.746, P = 0. 545 ）. At a cutoff point of 41.2 cm and 47.0 cm,the sensitivity , specificity of NC for diagnosis of OSA were 74.3% ,71.4% and 71.4% ,71.4% respectively. Conclusion Both NC and ANC are simple and valid indices for screening OSA in patients with AF.