柏林问卷在阻塞性睡眠呼吸暂停低通气综合征筛查中的应用价值

Application of Berlin questionnaire in the screening of obstructive sleep apnea hypopnea syndrome

目的 评价柏林问卷对OSAHS的筛查价值.方法以疑诊为OSAHS的患者为研究对象,进行柏林问卷调查及多导睡眠（polysomnogram,PSG）监测.根据柏林问卷结果将患者分为OSAHS高危组和低危组,根据PSG监测结果将患者分为非OSAHS组及轻、中、重度OSAHS组.比较各组患者的性别、年龄、体重指数、呼吸暂停低通气指数（apnea hypopnea index,AHI）及柏林问卷结果的差异.对柏林问卷结果与患者的年龄、呼吸暂停低通气指数、最低经皮血氧饱和度（the lowest SpO2,LSpO2）、微觉醒指数的关系进行相关性分析.将柏林问卷结果和PSG监测结果以四格表计算其敏感度、特异度、假阴性率、假阳性率、阳性似然比、阴性似然比及符合率等,判断其结果的真实性和可靠性.结果 共纳入OSAHS患者302例,其中男226例（74.8%）,女76例（25.2%）,年龄21～82岁,平均（50±14）岁,平均体重指数（28±5）kg/m2.柏林问卷危险度分级比较,非OSAHS组与轻度、中度及重度OSAHS组间差异有统计学意义（χ2=13.961,8.466,42.156,均P〈0.0083）;重度OSAHS组与轻度、中度OSAHS组间差异有统计学意义（χ2=9.439,11.162,均P〈0.0083）;轻度与中度OSAHS组间差异无统计学意义（P＞0.0083）.病情较重者中,柏林问卷提示OSAHS高危与PSG诊断符合率较高（χ2=34.211,P〈0.001）.柏林问卷结果分级与患者的性别无相关性（P＞0.0083）,与年龄、AHI及微觉醒指数正相关（r=0.125,0.346,0.198,均P〈0.05）,与LSpO2负相关（r=-0.371,P〈0.01）.柏林问卷筛查OSAHS的敏感度为71%,特异度为72%.结论 柏林问卷对OSAHS的筛查诊断具有一定的意义,柏林问卷评分与病情严重程度呈正相关,柏林问卷诊断重度OSAHS的敏感度较高.

Objective To investigate the value of Berlin questionnaire in screening obstructive sleep apnea hypopnea syndrome（OSAHS） among Chinese. Methods A total of 302 cases with suspected OSAHS were referred to our sleep laboratory. The Berlin questionnaire scores and polysomnography（PSG） monitoring data were analyzed. According to the Berlin questionnaire score, the patients were divided into high and lower risk groups for OSAHS . In terms of the PSG monitoring results, the patients were classified into non-OSAHS, mild, moderate and severe OSAHS groups. The age, gender, apnea hypopnea index（AHI）, body mass index, and the Berlin questionnaire（BQ） result were compared among the 4 groups. The correlation of Berlin questionnaire result with age, AHI, the lowest SpO2 （LSpO2） and microarousal index（MAI） were analyzed.Results There were significant differences in the Berlin questionnaire results among non-OSAHS and the other 3 groups（χ2=13.961, 8.466, 42.156,P〈0.0083）; and between the severe OSAHS and the other 2 groups（χ2=9.439,11.162,P〈0.0083）. There was no statistical difference between the mild and moderate groups（P〉0.0083）. The ratio of the high BQ risk patients had an increasing tendency as the severity of OSAHS was increased （χ2=34.211,P〈0.01）. The Berlin questionnaire results showed a positive correlation with age, AHI or MAI（r=0.125, 0.346,0.198,all P〈0.05, respectively） but a negative correlation with LSpO2（r=-0.371, P〈0.01）. The Berlin questionnaire results showed no correlation with gender （P〉0.05）. The sensitivity and the specificity of the Berlin questionnaire in predicting sleep apnea were 0.71 and 0.72, respectively.Conclusions With the moderate sensitivity and the specificity, the Berlin questionnaire has some value in screening patients with OSAHS. However, it is not correlated with the severity of OSAHS in Chinese patients. Thus Berlin questionnaire has limited value in the screening of OSAHS among Chinese.