阻塞性睡眠呼吸暂停筛查量表在急性缺血性脑卒中患者中的应用评价

Screening efficiencies of obstructive sleep apnea screening scales in patients with acute ischemic stroke

目的:探讨常用阻塞性睡眠呼吸暂停(OSA)筛查量表在急性缺血性脑卒中患者中的应用价值。方法:连续收集2016年7月至2017年3月在浙江大学医学院附属邵逸夫医院住院治疗的急性缺血性脑卒中患者102例,由同一名医生完成OSA筛查量表评估,包括Epworth量表、柏林问卷、STOP-Bang问卷、SOS量表、四变量评分和改良四变量评分。同时由睡眠中心完成多导睡眠监测。根据睡眠呼吸暂停低通气指数(AHI)将患者分成中重度OSA组(AHI≥15,58例)和正常或轻度OSA组(AHI<15,44例)。比较各筛查量表对急性缺血性脑卒中患者合并中重度OSA的筛查能力。结果:ROC曲线分析结果显示,各量表中,四变量评分和改良四变量评分预测中重度OSA的ROC曲线下面积最高,分别为0.806和0.807(均P<0.01)。根据ROC曲线,Epworth量表、柏林问卷、STOP-Bang问卷、SOS量表、四变量评分和改良四变量评分预测中重度OSA的最佳临界值分别为9、2、4、15、11和10。其中,四变量评分和改良四变量评分预测中重度OSA的敏感度、特异度、阳性预测值、阴性预测值等各项指标总体来看优于其他量表。结论:Epworth量表、柏林问卷、STOP-Bang问卷和SOS量表对急性缺血性脑卒中患者的筛查效率较低,而四变量评分和改良四变量评分的筛查效率较高。

Objective： To evaluate the application of various obstructive sleep apnea（ OSA） screening scales in patients with acute ischemic stroke. Methods： One hundred and two patients with acute ischemic stroke were enrolled continuously during July 2016 and March 2017 from Sir Run Run Shaw Hospital,Zhejiang University School of Medicine. All patients were assessed by the same physician with various OSA screening scales,including Epworth scale,Berlin questionnaire,STOP-Bang questionnaire,SOS scale,four-variable scale and its modified version. Polysomnography was performed in Sleeping Disorder Center on each patient. According to the apnea-hypopnea index（ AHI） acquired from polysomnography,patients were divided into moderate-severe OSA group（ AHI≥15,n = 58） and normal-mild OSA group（ AHI 15,n = 44）. The efficiencies of the scales in identification of patients with moderate or severe OSA were analyzed and compared. Results： The ROC curves showed that the four-variable scale and its modified version had higher area under curve（ 0. 806 and 0. 807,both P〈0. 01） for diagnosis of moderate-severe OSA,and the cut-off values for Epworth scale,Berlin questionnaire,STOP-Bang questionnaire,SOS scale,four-variable scale and its modified version were 9, 2, 4, 15, 11, 10, respectively. The sensitivities,specificities,positive and negative predictive values of four-variable scale and its modified version in diagnosis of moderate-severe OSA were higher than those of other scales. Conclusion： Compared with Epworth scale,Berlin questionnaire,STOP-Bang questionnaire and SOS scale,the four-variable scale and its modified version are more effective in screening of OSA for patients with acute ischemic stroke.