不同体质指数界值下Berlin问卷筛查阻塞性睡眠呼吸暂停患者的准确性  

Accuracy of Berlin questionnaire with different body mass index cutoff values in the screening of patients with obstructive sleep apnea

作　　者：李哲[1] 唐向东[2] 

机构地区：[1]四川省医学科学院四川省人民医院心身医学中心,成都610072 [2]四川大学华西医院睡眠医学中心

出　　处：《中华医学杂志》2017年第12期911-914,共4页National Medical Journal of China

基　　金：国家自然科学基金（81500072）

摘　　要：目的评估不同体质指数（BMI）界值下Berlin问卷筛查阻塞性睡眠呼吸暂停（OSA）患者的准确性。方法收集2011年9月至2012年5月在四川大学华西医院睡眠医学中心连续就诊的可疑350例OSA患者[男302例，女48例；年龄19～68岁，平均（42.9±11.0）岁]，进行整夜多导睡眠图（PSG）监测，并填写Berlin问卷。依据呼吸暂停低通气指数（AHI）将患者分为单纯鼾症组（〈5次/h）、轻度OSA组（5～〈15次/h）、中度OSA组（15～〈30次/h）、重度OSA组（≥30次/h）。计算调整BMI界值后Berlin问卷的敏感度、特异度、阳性预测值、阴性预测值，绘制受试者工作特征（ROC）曲线，分析不同BMI界值下Berlin问卷预测OSA的准确性。结果在BMI界值≥30 kg/m2时，Berlin问卷判断轻－中－重（AHI≥5次/h）、中－重（AHI≥15次/h）、重度（AHI≥30次/h）OSA的敏感度分别为69.2%、71.6%、76.6%，阴性预测值分别为15.7%、33.0%、56.5%；在BMI界值≥24 kg/m2时，其敏感度和阴性预测值最高（分别为94.3%、94.8%、96.7%和28.0%、44.0%、72.0%）。结论随着BMI界值降低，Berlin问卷敏感度及阴性预测值逐步提高，但特异度及阳性预测值降低，Berlin量表的准确性可能与BMI有关。Objective To evaluate the accuracy of Berlin questionnaire in the screening of patients with obstructive sleep apnea （OSA）, after using different body mass index （BMI） cutoff values. Methods The data were collected from September, 2011 to May, 2012 at the Sleep Medicine Center of West China Hospital, Sichuan University （Chengdu, China ）. A total of 350 consecutive patients （302 males and 48 females, 19-68 years old, average （42. 9 ± 11.0） years old） with suspected OSA who underwent an overnight polysomnography （PSG） were recruited into this study. Berlin questionnaire was completed. Based on the severity of OSA which were determined by apnea-hypopnea index （AHI）, the patients were classified into four groups of primary snoring （ 〈 5 events/h ） , mild （ 5 - 〈 15 events/h ）, moderate （ 15 - 〈 30 events/h） and severe OSA （≥ 30 events/h）. Sensitivity, specificity, positive predictive values, negative predictive values and the area under the receiver operating characteristics curve of Berlin questionnaire with different BMI cutoff values were calculated. Results In patients with BMI ≥30 kg/m2 , to diagnose mild-moderate-severe （ AHI ≥ 5 events/h）, moderate-severe （ AHI ≥ 15 events/h）, and severe （AHI ≥30 events/h） OSA, the sensitivity of Berlin questionnaire were 69. 2%, 71.6%, and 76. 6% ; the negative predictive values were 15.7%, 33.0%, and 56.5%, respectively. In patients with BMI≥24 kg/m2, questionnaire had the highest sensitivity （ 94. 3%, 94. 8%, and 96. 7%, respectively ） and negative predictive values （28.0%, 44. 0%, and 72. 0%, respectively）. Conclusions When BMI cutoff values gradually declines, the sensitivity and negative predictive values of Berlin questionnaire increase, but the specificity and positive predictive values decline. The accuracy of Berlin questionnaire possibly is related to BMI cutoff values.

关 键 词：睡眠呼吸暂停 阻塞性 问卷调查 人体质量指数 多导睡眠描记术 

分 类 号：R766[医药卫生—耳鼻咽喉科]