睡眠内镜对OSAHS阻塞平面定位诊断的系统评价和Meta分析

The clinical value of sleep endoscopy in the diagnosis of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome:a systematic review and Meta-analysis

目的:系统评价诱导睡眠状态下电子鼻咽喉镜检查对于OSAHS成人患者上气道多平面阻塞诊断的临床价值。方法:按照Cochrane系统评价的方法,检索MEDLINE(PubMed)、EMBASE、CCTR(The Cochrane Controlled Clinical Trials Register Database)、中国知网、万方数据库等。检索国内外发表的截止2016年1月关于睡眠内镜在OSAHS定位诊断中的临床应用价值的研究。使用分析软件Meta-Disc1.4对提取的数据进行统计学分析。结果:最终纳入定性研究的文献7篇,纳入定量分析的文献3篇,纳入定量分析的研究试验3个,共175例患者,合并敏感度、特异度及95%CI分别为1.0(0.96~1.0)、0.71(0.59~0.81),合并诊断比值比为212.47(36.07~1 251.56),合并阳性似然比(+LR)、合并阴性似然比(-LR)分别为4.40(1.28~15.16)、0.02(0~0.11),纳入研究的SROC曲线下面积为0.991 0。结论:纳入研究统计学分析的结果提示睡眠内镜对OSAHS患者上气道多平面阻塞的诊断敏感性高,可以作为OSAHS诊断的重要辅助检查。但是纳入的文献数量有限,还需要更多大样本的质量高的队列研究试验来进一步检验。

Objective：To investigate the clinical value of video laryngoscope in localization diagnosis of upper airway obstruction in OSAHS during drug-induced sleep. Method： We searched the MEDLINE （PubMed）, EM BASE, CCTR （The Coehrane Controlled Clinical Trials Register Database）, CNKI, WAN FANG databases for randomized, blinded studies according Cochrane systematic review. We chose articles published between 1975 and 2016 about the value of sleep endoscopy in localization diagnosis of upper airway obstruction in OSAHS. All the data were analyzed by the software of the Meta-Disc 1.4. Result： Seven qualitative studies and three quantitative studies were included. A total of three studies with 175 patients met the inclusion criteria for Meta-analysis. Meta analysis results showed that the merger sensitivity degrees, specific degrees, diagnostic odds ratio, positive likeli- hood ratio, negative likelihood ratio and 95%CI were 1.0（0.96 1.0）, 0.71（0.59-0.81）, 212.47 （36.07- 1 251.56）, 4.40（1.28-15.16）, and 0.02 （0-0.11） respectively. The SROC area under the concentration-time curve （AUC） was 0. 991 0. Conclusion： Because of its high accuracy, sleep endoscopy can be used as an important auxiliary examination and the sensitive indexes for the surgery procedures and prognosis treatment plan for OS- AHS. But more cohort studies are needed for the verification.