女性阻塞性睡眠呼吸暂停低通气综合征筛查模型的应用效果研究

Study on the application effect of the female OSAHS screening model

目的评价女性OSAHS筛查模型的筛查效果,检验其预测女性罹患阻塞性睡眠呼吸暂停(OSA)的能力。方法采用便利抽样法,选取2018年3月—2019年1月在2家三级甲等医院进行多导睡眠监测、符合纳入标准的女性为研究对象,由研究者本人一对一询问并填写调查问卷,共收集245名女性资料。根据呼吸暂停低通气指数(AHI)将研究对象进行分组,计算女性OSAHS筛查模型灵敏度和特异度、阳性预测值、阴性预测值,根据Youden指数、符合率、Kappa值、ROC曲线及曲线下面积,判断女性OSAHS筛查模型的筛查效果。结果245例女性中,非OSA 108例,OSA 137例。女性OSAHS筛查模型筛查得分与AHI呈正相关(r=0.654,P<0.01),与BMI、MMP分级、打鼾年限呈正相关,与夜间平均血氧饱和度呈负相关(P<0.01);筛查模型的各项条目按阈值划分在OSA患者和非OSA患者中差异均有统计学意义(P<0.01)。女性OSAHS筛查模型的ROC曲线下面积0.845(95%CI:0.797~0.893),表明女性OSAHS筛查模型对OSA具有中度预测能力;以7分为切分值,AHI≥5次/h时,模型筛查OSA的符合率为74.7%,女性OSAHS筛查模型对预测OSA具有中度一致性;以6分为切分值时均有最大Youden指数,此时灵敏度分别为86.1%、93.6%、96.9%,特异度分别为63.9%、59.6%、47.8%。结论女性OSAHS筛查模型有中度预测价值,对女性OSA有较好的筛查效果,应进一步验证、推广。

Objective To evaluate the screening effect of the female obstructive sleep apnea(OSAHS/OSA)screening model and test its ability to examine OSA.Methods From March 2018 to January 2019,245 women who met the inclusion criteria for polysomnography monitoring in two ClassⅢGrade A hospitals were selected as the research objects.The researcher asked the objectives one by one and filled in the questionnaire.Subjects were grouped according to Apnea Hypopnea Index(AHI)to calculate the sensitivity and specificity,positive predictive value and negative predictive value of the OSAHS screening model of female snorers.The screening effect of the female OSAHS screening model was determined according to the Youden Index,coincidence rate,Kappa value,ROC curve and its area.Results Among 245 women,108 were non-OSA and 137were OSA.The scores of female OSAHS screening model was positively correlated with AHI(r=0.654,P<0.01),positively correlated with BMI,MMP grading and snoring years,and negatively correlated with night mean oxygen saturation(P<0.01).The differences of screening model items between OSA group and non-OSA group were statistically significant(P<0.01).The area under ROC curve of the female OSAHS screening model was 0.845(95%CI:0.797-0.893),which indicated that the female OSAHS screening model had moderate ability ofpredicting OSA.The coincidence rate of model screening OSA was 74.7%divided by 7 points when AHI was no less than 5 events/h,and the female OSAHS screening model has moderate consistency in predicting OSA.When the cut-off values were set to be 6 points,the Youden index was the highest,and the sensitivity was 86.1%,93.6%,96.9%,the specificity was 63.9%,59.6%and 47.8%respectively.Conclusions The female OSAHS screening model has moderate predictive value and good screening effect for female OSA.It should be further validated and promoted.