NoSAS评分和女性阻塞性睡眠呼吸暂停低通气综合征筛查模型在女性阻塞性睡眠呼吸暂停筛查中的应用

Validation of NoSAS Score and Obstructive Sleep Apnea Hypopnea Syndrome Screening Model for Female Snorers in Females with Obstructive Sleep Apnea

目的评估NoSAS评分与女性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)筛查模型在女性人群中对阻塞性睡眠呼吸暂停(OSA)的筛查效果,并对两种筛查工具进行比较。方法收集425例行多导睡眠呼吸监测女性的资料,包括NoSAS评分、女性OSAHS筛查模型的筛查结果。依据呼吸暂停低通气指数(AHI)将患者分为4组:非OSA组(AHI<5次/h)、OSA组(AHI≥5次/h)、中重度OSA组(AHI>15/h)和重度OSA组(AHI>30次/h),评估2种筛查工具的筛查效果。结果在OSA组、中重度OSA组和重度OSA组中,NoSAS评分的灵敏度和特异度分别为57.3%、64.9%、69.5%和83.5%、76.6%、70.9%;女性OSAHS筛查模型的灵敏度和特异度分别为62.7%、74.8%、75.8%和92.5%、84.3%、74.5%;两种工具均有较高的特异度,可有效排除女性人群中的非OSA患者。AHI≥5次/h时,NoSAS评分和女性OSAHS筛查模型的筛查结果与OSA诊断结果均有中、高度一致性,Kappa值分别为0.401、0.541;两种工具的接收者工作特征曲线(ROC)下面积分别为0.792(95%CI=0.750~0.829)、0.866(95%CI=0.830~0.897),均有中度筛查价值。不同病情严重程度下,女性OSAHS筛查模型的ROC曲线下面积均大于NoSAS评分(P=0.002,P=0.003,P=0.019)。结论两种筛查工具对女性人群均有中度筛查价值。与NoSAS评分相比,女性OSAHS筛查模型在女性人群中的筛查效果较好,但灵敏度仍需提高。

Objective To evaluate the NoSAS score and the obstructive sleep apnea hypopnea syndrome(OSAHS)screening model for female snorers with obstructive sleep apnea(OSA)in females and compare the performance of these two tools.Methods A total of 425 females with suspected OSA who underwent overnight polysomnography(PSG)were consecutively recruited into this study.The above two questionnaires were completed.Based on the severity of OSA which was determined by apnea-hypopnea index(AHI),the patients were classified into four groups:non-OSA group(AHI<5 events/h),OSA group(AHI≥5 events/h),moderate-to-severe OSA group(AHI>15 events/h),and severe OSA group(AHI>30 events/h).The sensitivity,specificity,positive predictive values,negative predictive values,and the area under the receiver operating characteristics(ROC)curve of two questionnaires were calculated.Results The sensitivity of NoSAS score for OSA,moderate-to-severe OSA,and severe OSA groups were 57.3%,64.9%,and 69.5%,and its specificity was 83.5%,76.6%,and 70.9%,respectively.The sensitivity of the OSAHS screening model of female snorers was 62.7%,74.8%,and 75.8%,and its specificity was 92.5%,84.3%,and 74.5%,respectively.Both of these two screening tools had high specificity and performed well in ruling out non-OSA females.For patients with their AHI≥5 events/h,the results of NoSAS score and OSAHS screening model were in moderate to high consistency with those diagnosed by PSG,with a Kappa value of 0.401 and 0.541,respectively.The area under curve of these two tools was 0.792(95%CI=0.750-0.829)and 0.866(95%CI=0.830-0.897),respectively,showing moderate screening value.The area under curve of the OSAHS screening model of female snorers was significantly larger than that of NoSAS score(P=0.002,P=0.003,P=0.019).Conclusions Both the NoSAS score and the OSAHS screening model for female snorers have a moderate performance in diagnosing OSA in females,although the OSAHS screening model for female snorers has better performance.However,the sensitivity of the OSAHS screening model needs to be further improved.