STOP-Bang问卷筛查重叠综合征的临床价值研究

Clinical Value of STOP-Bang Questionnaire in Screening Overlap Syndrome

目的评价STOP-Bang问卷(SBQ)用于筛查重叠综合征(OS)的临床价值。方法选取2015年6月—2017年4月在无锡市人民医院呼吸科就诊且疑诊OS的慢性阻塞性肺疾病(COPD)患者320例,患者均接受多导睡眠监测(PSG)检查,并同时在专业医护人员指导下填写SBQ,分析两者相关性。并根据睡眠呼吸暂停低通气指数(AHI)将患者分为5≤AHI≤15、15<AHI≤30、AHI>30 3组,分析SBQ预测OS的灵敏度、特异度、阳性预测值和阴性预测值,并绘制受试者工作特征(ROC)曲线。结果 SBQ与年龄、第1秒用力呼气末容积(FEV1)/用力肺活量(FVC)、混合性呼吸暂停指数(MAI)无直线相关关系(r_s=0.061,P=0.279;r_s=-0.910,P=0.102;r_s=0.181,P=0.511);SBQ与体质指数(BMI)、AHI、低通气指数(HI)、阻塞性睡眠呼吸暂停指数(OAI)、中枢性呼吸暂停指数(CAI)、氧减指数(ODI)呈正相关(r_s=0.032,P<0.001;r_s=0.538,P<0.001;r_s=0.403,P<0.001;r=0.526,P<0.001;r_s=0.265,P<0.001;r_s=0.506,P<0.001);SBQ与FEV1呈负相关(r_s=-0.130,P=0.016)。SBQ诊断OS的灵敏度为99.2%,特异度为85.6%,阳性预测值为80.1%,阴性预测值为99.4%。SBQ预测5≤AHI≤15的OS患者的ROC曲线下面积(AUC)为0.915(0.737,0.957),最佳诊断界值为2分;预测15<AHI≤30的OS患者的AUC为0.861(0.812,0.910),最佳诊断界值为5分;预测AHI>30的OS患者的AUC为0.769(0.641,0.895),最佳诊断界值为6分。结论筛查OS时,SBQ与PSG主要检查指标具有相关性,是一个较好的筛查和预测OS的工具,值得临床推广。

Objective To evaluate the clinical value of STOP-Bang questionnaire( SBQ) in screening overlap syndrome( OS). Methods The enrolled 320 participants were all from Department of Respiratory Medicine,Wuxi People' s Hospital. They were diagnosed as chronic obstructive pulmonary disease( COPD) and suspected with OS and received treatment between June 2015 and April 2017. All of them underwent polysomnography( PSG) and filled in the SBQ under the guidance of healthcare providers. Correlations of the values of main polysomnographic parameters for evaluating the severity of sleep disordered breathing and SBQ score were analyzed. Based on the value of apnea-hypopnea index( AHI),the patients were divided into three groups: 5 ≤ AHI ≤ 15 group,15 < AHI ≤ 30 group and AHI > 30 group. We evaluated the sensitivity,specificity,positive and negative predictive values,draw ROC curve and calculated the areas under ROC curve( AUC) for SBQ score to predict OS. Results SBQ score had no significant linear correlation with age( r_s= 0. 061,P = 0. 279),FEV1/FVC ratio( r_s=-0. 910,P = 0. 102),and the value of mixed apnea index( r_s= 0. 181,P = 0. 511). SBQ score was positively correlated with the value of BMI( r_s= 0. 032,P < 0. 001),AHI( r_s= 0. 538, P < 0. 001), hypopnea index( HI)( r= 0. 403,P < 0. 001),obstructive apnea index( OAI)( r_s= 0. 526,P < 0. 001),central apnea index( CAI)( r_s= 0. 265,P < 0. 001),and oxygen desaturation index( ODI)( r_s= 0. 506,P < 0. 001),while it was negatively correlated with the value of FEV1( r_s=-0. 130,P = 0. 016). For the diagnosis of OS,the SBQ score displayed its sensitivity as 99. 2%,specificity as85. 6%,positive predictive value as 80. 1% and negative predictive value as 99. 4%. The AUC of SBQ score for the prediction of OS in 5 ≤ AHI ≤ 15 group,15 < AHI ≤ 30 group and AHI > 30 group were 0. 915( 0. 737,0. 957),0. 861( 0. 812,0. 910),0. 769( 0. 641,0. 895),respectively,and its optimal cutoff value for the prediction of OS in these three groups were2,5,6,respectively. Conclusion In screening OS,SBQ score is correlated with the values of main parameters of PSG. It can be served as a good tool for screening and predicting OS,and is worthy of clinical application.