STOP-Bang问卷联合改良的Mallampati评分在预测阻塞性睡眠呼吸暂停中的临床价值

目的探讨STOP-Bang问卷(SBQ)联合改良的Mallampati评分(MM)在预测阻塞性睡眠呼吸暂停(OSA)中的作用。 方法选择就诊于安徽医科大学第二附属医院呼吸睡眠中心的患者40例，完善SBQ及MM，并于入住当晚行多导睡眠监测(PSG)，按呼吸暂停低通气指数(AHI)分为>5次/h、>15次/h、>30次/h三组，根据结果分别计算SBQ≥3分、MM≥Ⅲ级以及SBQ≥3分联合MM≥Ⅲ级预测OSA的灵敏度、特异度、阳性预测值、阴性预测值。 结果该研究共筛查患者44例，纳入合格受试者40例，其中男性34例(85%)，女性6例(15%)，年龄(45.1±14.6)岁，颈围(43.5±5.9)cm，体质量指数(BMI)28.87(26.35～32.13)kg/m²，AHI 50.6(16.22～70.98)次/h，未患OSA 3例(7.5%)，轻度OSA 1例(2.5%)，中度OSA 6例(15%)，重度OSA 30例(75%)。SBQ≥3分预测OSA的灵敏度最高(分别为91.89%、91.67%、93.33%)，但特异度最低(分别为33.33%、25.00%、20.00%)。MM≥Ⅲ级预测OSA的灵敏度为78.39%、80.56%、83.33%，特异度为33.33%、50%、40%。SBQ≥3分或MM≥Ⅲ级预测OSA的灵敏度均较高，但特异度均不理想。两者联合预测OSA的特异度显著提高(66.67%、75.00%、50.00%)，而灵敏度仅稍降低(75.68%、77.78%、80.00%)，其中，只有中重度OSA (AHI>15次/h)通过了与PSG的Kappa一致性检验(P<0.05)。 结论将就诊于睡眠中心的患者进行SBQ及MM评分，SBQ≥3分联合MM≥Ⅲ级可显著提高预测OSA的特异度，同时具有良好的灵敏度，尤其对中重度OSA的预测与PSG具有较好的一致性，可用于OSA的筛查。

Clinical value of STOP-Bang questionnaire and modified mallampati score in predicting obstructive sleep apnea

ObjectiveTo assess the clinical value of STOP-Bang questionnaire (SBQ) and modified mallampati score (MM) in predicting obstructive sleep apnea (OSA). MethodsA total of 40 cases (6 females and 34 males) hospitalized in the Respiratory Sleep Center of our hospital were enrolled in this study. All the patients were prospectively predicted for risk of OSA using SBQ and MM, and their sleep quality was monitored by polysomnography (PSG). According to the apnea-hypopnea index (AHI), the patients were divided into three groups: AHI>5/h group, AHI>15/h group, and AHI>30/h group. Then all the patients received SBQ and MM assessment. Finally, we calculated the sensitivity, specificity, positive predictive values and negative predictive values for all the patients of both scores separately and in combination. ResultsIn this study, 44 patients were screened and 40 eligible subjects were included, including 34 males (85%) and 6 females (15%). Their average age was (45.1±14.6) years, their average neck circumference was (43.5±5.9)cm, their average body mass index (BMI) was 28.87 (26.35-32.13) kg/m^2, and their average AHI was 50.6 (16.22-70.98)/h. No OSA was found in 3 cases (7.5%), mild OSA in 1 case (2.5%), moderate OSA in 6 cases (15%) and severe OSA in 30 cases (75%). The results showed that SBQ≥3 had higher sensitivities (91.89%, 91.67%, and 93.33%, respectively) in predicting OSA, but lower specificities (33.33%, 25.00%, and 20.00%, respectively) were found. The sensitivities of MM≥Ⅲ in predicting OSA were 78.39%, 80.56%, 83.33%, respectively, and the specificities were 33.33%, 50%, 40%, respectively. The sensitivity of SBQ≥3 or MM≥Ⅲ in predicting OSA was higher, but the specificity was not ideal. The specificities (66.67%, 75.00%, and 50.00%, respectively) in predicting OSA were significantly improved by the combination of the two methods, and the sensitivities (75.68%, 77.78%, and 80.00%, respectively) were only slightly reduced. Among them, only moderate and severe OSA (AHI>15/h) passed the Kappa consistency test with PSG (P<0.05). ConclusionThe combination of SBQ≥3 and MM≥Ⅲ for the patients treated in our sleep center can significantly improve the specificity in predicting OSA and at the same time has good sensitivity, especially for the patients with moderate or severe OSA. It has good consistency with PSG, therefore, it can be used for OSA screening.