夜间最低血氧饱和度联合睡眠相关量表筛查儿童阻塞性睡眠呼吸暂停的应用

目的 评价夜间最低血氧饱和度(LSaO₂)联合OSA-18量表和针对儿童的改良版Epworth嗜睡量表(ESS-CHAD)初筛儿童阻塞性睡眠呼吸暂停(OSA)的准确性,以探讨更简便、快捷、可行的基层医院初筛疑似儿童OSA的方法。方法 纳入2020年8月13日—2021年2月8日就诊于本院耳鼻咽喉头颈外科睡眠监测中心完成整夜多导睡眠监测的儿童139例作回顾性分析研究,其家长在医生协助下完成OSA-18量表和ESS-CHAD。分析LSaO₂和两种量表及三者联合早期初筛疑似儿童OSA的诊断价值。结果 LSaO₂预测儿童是否患OSA的最佳界值为90.5%(P<0.00, AUC=0.82)。OSA-18和ESS-CHAD依据不同界值分别诊断儿童OSA的灵敏度最高,分别为74.8%、22.7%。LSaO₂/OSA-18,LSaO₂/ESS-CHAD、OSA-18/ESS-CHAD诊断儿童OSA的灵敏度最高,分别为88.2%、68.1%、77.3%。 结论 LSaO₂有诊断儿童OSA的临床价值,OSA-18量表较ESS-CHAD初筛疑似儿童OSA有更高的灵敏度,但特异度低,LSaO₂联合OSA-18量表诊断儿童OSA的灵敏度、特异度均较其他联合诊断方式高。在无法进行睡眠监测的基层医院可考虑应用LSaO₂ 与OSA-18量表结合的方式初步筛查儿童OSA。

Application of nocturnal lowest oxygen saturation combined with sleep-related scales in screening obstructive sleep apnea in children

Objective To evaluate the accuracy of nocturnal lowest oxygen saturation (LSaO₂ ) at night combined with OSA-18 scale and modified Epworth Sleepiness Scale for Children (ESS-CHAD ) in primary screening of obstructive sleep apnea (OSA ) in children, so as to explore a simpler, faster and feasible method for primary screening of suspected OSA in children. Methods A total of 139 children who completed overnight polysomnography (PSG) in the Department of Otolaryngology Head and Neck Surgery of Second Affiliated Hospital of Xi′an Jiaotong University were enrolled in this study from 13rd, August 2020 to 8th February 2021. Their parents completed OSA-18 and ESS-CHAD with the assistance of doctors. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and ROC curve of the serial tests were calculated, respectively. Results According to the ROC curve, the optimal cut-off value of nocturnal LSaO₂ for predicting OSA in children was 90.5% (P<0.001, AUC=0.82). The highest sensitivity of OSA-18 and ESS-CHAD for diagnosing OSA was 74.8% and 22.7%, respectively. The highest sensitivity of LSaO₂/OSA-18, LSaO₂/ESS-CHAD, OSA-18/ESS-CHAD in the diagnosis of OSA in children was 88.2 %, 68.1% and 77.3%, respectively. Conclusions The nocturnal LSaO₂ has clinical value in the diagnosis of OSA in children. OSA-18 has higher sensitivity but lower specificity than ESS-CHAD. The sensitivity and specificity of LSaO₂ combined with OSA-18 in diagnosing OSA are higher than the remaining serial tests, which could be used in primary screening OSA in children at grassroots hospitals where sleep monitoring is impossible.