阻塞性睡眠呼吸暂停诊断模型的前瞻性研究  

Prospective study on the diagnostic model of obstructive sleep apnea

作　　者：孙楷[1] 雷飞[2] 郑艾波 周丽萍 马升军[1] 刘泳[1] 彭娟[1] SUN Kai;LEI Fei;ZHENG Aibo;ZHOU Liping;MA Shengjun;LIU Yong;PENG Juan(Department of Pulmonary and Critical Care Medicine,Zigong Fourth People’s Hospital,Zigong,Sichuan 643000,P.R.China;Sleep Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]自贡市第四人民医院呼吸与危重症医学科,四川自贡643000 [2]四川大学华西医院睡眠医学中心,四川成都610041

出　　处：《中国呼吸与危重监护杂志》2025年第2期92-96,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：四川省自贡市2022年重点科技计划(2022ZCYGY07)。

摘　　要：目的前瞻性验证阻塞性睡眠呼吸暂停(obstructive;diagnostic model,OSA)诊断模型(包括患病概率模型和疾病严重程度模型)的准确性和可靠性,探讨一种简便经济的OSA初筛诊断方法。方法连续前瞻性纳入在自贡市第四人民医院(590例)和四川大学华西医院(406例)行PSG监测的996例患者作为研究对象;先通过OSA诊断模型进行诊断试验;再行PSG监测;最后以PSG监测为金标准,计算OSA诊断模型的灵敏度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比、阴性似然比和ROC曲线下面积,并对模型预测结果进行可靠性分析。结果OSA诊断模型的灵敏度、特异度、准确度分别为76.38%(595/779)、83.41%(181/217)、77.91%(776/996),阳性预测值为94.29%、阴性预测值为45.49%、阳性似然比为4.604、阴性似然比为0.283;ROC曲线下面积为0.866;OSA诊断模型的可靠性分析显示AHI的偏倚比较差异无统计学意义;OSA诊断模型AHI与PSG监测AHI的组内相关系数(ICC)为0.659,一致性程度较强;OSA诊断模型最低SpO_(2)与PSG监测最低SpO_(2)的组内相关系数为0.563,一致性程度中等。结论OSA诊断模型能较好的预测患病概率及评估疾病严重程度,有助于OSA早发现、早诊断、早治疗,OSA诊断模型适合在基层医院和当PSG监测不可及时推广应用。Objective To prospectively verify the accuracy and reliability of the diagnostic model of obstructive sleep apnea(OSA),including the probability model and disease severity model,and to explore a simple and cost-effective method for screening of OSA.Methods A total of 996 patients who underwent polysomnography in Zigong Fourth People’s Hospital(590 cases)and West China Hospital of Sichuan University(406 cases)were consecutively and prospectively included as the research subjects.Firstly,the OSA diagnostic model was used for the diagnostic test;then polysomnography was performed;Finally,taking polysomnography as the gold standard,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and area under the ROC curve of OSA diagnostic model were calculated,and the reliability analysis of the model’s results was carried out.Results The sensitivity,specificity and accuracy of the OSA diagnostic model were 76.38%(595/779),83.41%(181/217)and 77.91%(776/996)respectively,the positive predictive value is 94.29%,negative predictive value is 45.49%,positive likelihood ratio is 4.604,negative likelihood ratio is 0.283;and the area under the ROC curve was 0.866.The reliability analysis of OSA diagnostic model showed that there was no significant difference in the bias comparison of AHI;the intra-class correlation coefficient(ICC)between AHI in the OSA diagnostic model and AHI in polysomnography was 0.659,with a relatively strong consistency degree;the intra-class correlation coefficient between the lowest SpO_(2)in the OSA diagnostic model and the lowest SpO_(2)in polysomnography was 0.563,with a moderate consistency degree.Conclusions The OSA diagnostic model can better predict the probability of illness and assess the severity of the disease,which is helpful for the early detection,diagnosis and treatment of OSA.The OSA diagnostic model is suitable for popularization and application in primary hospitals and when polysomnography is not avail

关 键 词：阻塞性睡眠呼吸暂停 诊断模型 前瞻性研究 多导睡眠监测 

分 类 号：R766[医药卫生—耳鼻咽喉科]