基于血清学的阻塞性睡眠呼吸暂停低通气综合征筛查模型的初步研究

目的探讨影响阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的影响因素,并建立筛查模型。方法选取2020年2月至2021年12月在本院拟诊为OSAHS患者100例,根据多导睡眠监测结果分为OSAHS组(n=57)和对照组(n=43),采用单因素分析和多因素Logistic回归分析获得独立影响因素,建立OSAHS筛查模型,绘制ROC曲线。结果单因素分析显示,OSAHS组患者嗜睡、暂停或憋醒、上呼吸道异常例数及体重指数(BMI)、血IMA水平均明显高于对照组,差异均有统计学意义(P<0.05),多因素Logistic回归分析显示,嗜睡、暂停或憋醒、上呼吸道异常例数及BMI、血IMA水平是OSAHS的独立影响因素(P<0.05),对其进行赋分并计算得分后绘制ROC曲线:AUC=0.948,95%CI:0.910~0.987(P<0.05),最佳临界值为36分,诊断界值下评分系统诊断工具的敏感度、特异度、阳性预测值、阴性预测值分别为87.7%、88.4%、90.9%、84.4%。结论嗜睡、暂停或憋醒、上呼吸道异常例数及BMI、血IMA水平对OSAHS患者具有较高的预测价值,成功建立OSAHS的筛查模型。

Objective To investigate the influencing factors affecting obstructive sleep apnea hypoventilation syndrome(OSAHS)and to develop a screening model.Methods 100 patients who were suspected of OSAHS in our hospital from February 2020 to December 2021 were randomly selected and divided into the OSAHS and the control groups based on polysomnography results.Univariate and multinomial logistic regression analyses were used to obtain independent influencing factors,build an OSAHS screening model,and plot receiver operating characteristic(ROC)curves.Results Univariate analysis showed that the number of cases of somnolence,sleep apnea or being woken by dyspnea,upper respiratory tract abnormalities,and body mass index(BMI)and blood ischemia modified albumin(IMA)levels were significantly higher in the OSAHS group than in the control group,and the differences were statistically significant(all P<0.05).The multinomial logistic regression analysis showed that the number of cases of somnolence,sleep apnea or being woken by dyspnea,upper respiratory tract abnormalities,and BMI and blood IMA levels were independent influencing factors of OSAHS.The ROC curve was plotted after assigning and calculating scores:AUC=0.948,95%CI:0.910~0.987(P<0.05),the best critical value was 36 points,and the sensitivity,specificity,positive predictive value,and negative predictive value of the diagnostic tool of the scoring system under the diagnostic threshold were 87.7%,88.4%,90.9%,and 84.4%,respectively.Conclusion Somnolence,sleep apnea,being woken by dyspnea,cases of upper airway abnormalities,and BMI and blood IMA levels have high predictive value for patients with OSAHS,while a screening model for OSAHS has been successfully established.