颈围联合HbA1c在肥胖伴OSA患者筛查中的价值分析

Analysis of the value of neck circumference combined with HbA1c in screening obese patients with OSA

目的筛选肥胖合并阻塞性睡眠呼吸暂停(OSA)患者的诊断指标,并评估这些指标在肥胖合并OSA患者中的筛查价值。方法对单纯性肥胖(32例)及肥胖合并OSA患者(87例)进行回顾性分析,完善一般资料测量,并于入住当晚行多导睡眠监测(PSG),且所有患者均于PSG监测次日清晨行口服葡萄糖耐量试验(OGTT)、血清糖化血红蛋白(HbA1c)、空腹血糖(FPG)及OGTT后2 h血糖(2hPG)检测,分析肥胖合并OSA的临床特点及影响因素。结果采用多因素Logistic回归分析显示OSA的独立影响因素主要包括颈围、HbA1c(P<0.05),受试者工作特征曲线(ROC)分析显示HbA1c、颈围的曲线下面积(AUC)分别为:0.813、0.909,均高于Epworth嗜睡量表及STOP-Bang评分(AUC分别为:0.638、0.739)。联合使用HbA1c和颈围指标可提高AUC至0.934,在肥胖合并OSA患者的诊断中灵敏度为85.1%,特异度为96.9%。结论对于肥胖患者,颈围及HbA1c联合检测具有良好的灵敏度及特异度,可用于肥胖合并OSA患者的筛查。

Objective To screen the diagnostic indicators of obese patients with obstructive sleep apnea(OSA)and to evaluate the screening effect of these indicators in obese patients with OSA.Methods Retrospective analysis was performed in 32 patients with simple obesity and 87 patients with obesity combined with OSA.The general data were improved and polysomnography(PSG)was performed on the night after admission,and in the morning after PSG monitoring,oral glucose tolerance test(OGTT),serum glycosylated hemoglobin(HbA1c),fasting plasma glucose(FPG)and postprandial 2 hours plasma glucose(2hPG)were measured to analyze the clinical characteristics and influencing factors of obesity complicated with OSA.Results Multivariate Logistic regression analysis showed that the independent influencing factors of OSA included neck circumference and HbA1c.The analysis of the working characteristic curve of the subjects(ROC)showed that the area under the curve(AUC)of HbA1c and neck circumference were 0.813 and 0.909 respectively,which were better than the Epworth sleepiness scale and STOP-Bang rating scale(AUC:0.638、0.739).The combined use of HbA1c and neck circumference could improve AUC to 0.934,with a sensitivity of 85.1%and specificity of 96.9%in the diagnosis of obese patients with OSA.Conclusion For obese patients,the combined detection of neck circumference and HbA1c has good sensitivity and specificity,which can be used for screening obese patients with OSA.