卜梦滢 黄蓉 肖毅 罗金梅 余丽君

[摘要] 目的 探索女性打鼾人群的阻塞性睡眠呼吸暫停低通气综合征（OSAHS）筛查模型。 方法 2017年1月～2018年2月于北京协和医院收集223例行睡眠呼吸监测的打鼾女性，进行女性OSAHS的危险因素及打鼾情况的调查与分析，根据Logistic回归系数对各指标进行赋分，建立筛查模型，计算筛查模型的积分，绘制ROC曲线，评价筛查效果。 结果 223例打鼾女性中有110例OSAHS患者和113例非OSAHS患者，体重指数（BMI）、月经状态、改良Mallampati分级（MMP）、打鼾年限及打鼾程度进入回归方程模型，P < 0.05。赋分情况：BMI≥24.55 kg/m2（3分），绝经（3分），MMP≥Ⅲ级（2分），打鼾年限≥10.25年（4分），重度打鼾（2分），该筛查模型积分范围为0～14分；ROC曲线下面积A为0.795，95%可信区间为（0.737，0.853），P < 0.001，差异有统计学意义，筛查模型积分=7分时，约登指数最大为0.452，因此将7分作为最佳切分值。本筛查模型以呼吸暂停低通气指数（AHI）≥5次/h为诊断标准时，其灵敏度、特异度、阳性预测值和阴性预测值分别为70.9%、74.3%、72.6%和71.8%。 结论 通过对女性打鼾人群的OSAHS危险因素与打鼾情况的研究分析，建立了女性打鼾人群OSAHS筛查模型，有一定的临床应用价值。

[关键词] 女性；打鼾；阻塞性睡眠呼吸暂停低通气综合征；筛查模型

[中图分类号] R766.43 [文献标识码] A [文章编号] 1673-7210（2018）04（c）-0167-05

Preliminary study of the obstructive sleep apnea hypopnea syndrome screening model for female snorers

BU Mengying1 HUANG Rong2 XIAO Yi2 LUO Jinmei2 YU Lijun1

1.Academy of Nursing， Chinese Academy of Medical Science， Peking Union Medical College， Beijing 100144， China； 2.Department of Respiratory Medicine， Chinese Academy of Medical Science， Peking Union Medical College Hospital， Beijing 100730， China

[Abstract] Objective To investigate the obstructive sleep apnea hypopnea syndrome （OSAHS） screening model for female snorers. Methods The clinical data of 223 female snorers， that had conducted sleep monitor in Peking Union Medical College Hospital from January 2017 to February 2018， was analyzed to investigate the risk factors of OSAHS and snoring conditions. According to the Logistic regression coefficient， the indices were assigned， a screening model was established， the score of the screening model was calculated and the ROC curve was plotted to evaluate the screening effect. Results There were 110 females diagnosed with OSAHS and the other 113 females were not. There were statistically significant significance in the body mass index （BMI）， menstrual status， modified Mallampati index （MMP）， number of year of snoring and degree of snoring categorized into Logistic regression equation model （P < 0.05）. The indices were assigned as BMI ≥ 24.55 kg/m2 （3 points）， menopause （3 points）， MMP ≥ Ⅲ class （2 points）， year of snoring ≥ 10.25 years （4 points）， degree of snoring was severe （2 points）. The screening model score ranged from 0 to 14 points， the area under the ROC curve A was 0.795， the 95% confidence interval was （0.737， 0.853）， which had significant difference （P < 0.001）. When the score got 7 points， Youden index was 0.452 the maximum， so 7 points were taken as the best division point. When screening model in this study set apnea hypopnea index （AHI） ≥ 5 times/h as standard of diagnosis， the sensitivity， specificity， positive predictive value， and negative predictive value were 70.9%， 74.3%， 72.6% and 71.8%. Conclusion Through this research of risk factors of OSAHS and snoring conditions of female snorers， the OSAHS screening model of female snorers is constructed， which has a certain clinical application value.

[Key words] Female； Snoring； Obstructive sleep apnea hypopnea syndrome； Screening model

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）是一种发病率高影响多系统的慢性疾病，早期诊断和治疗非常重要[1-2]。美国学者Young等[3]在中年男女OSAHS患者进行临床诊断比例评估的研究中发现，中重度OSAHS患者中有93%的女性及82%的男性未获得临床诊断，轻度OSAHS患者中有98%的女性及90%的男性未被诊断，女性OSAHS患者的病情程度相对较轻、症状不典型，导致临床医务工作者不能有效的识别女性患者可能是导致女性OSAHS患者漏诊率更高的原因之一。OSAHS患者漏诊率高是该领域亟待解决的难题，而目前睡眠呼吸监测等待时间长、耗时和费力，因此有效、便捷地筛查是降低漏诊率的重要手段。目前在国内外[4-5]OSAHS筛查中广泛应用的Berlin、STOP、STOP-Bang三个问卷的灵敏度在70%以上，特异度在50%以下，灵敏度尚可而特异度欠佳。Silva等[6]在关于性别对伴有鼾声的人群进行OSAHS筛查……