成人癫痫患者中阻塞性睡眠呼吸暂停筛查工具的性能特征

文献信息

中文摘要

理由： 阻塞性睡眠呼吸暂停（OSA）是成人癫痫（AWE）中一种高度普遍但常被忽视的共病。在一般人群中广泛使用的筛查工具包括STOP（打鼾、疲劳、观察到呼吸暂停、高血压）和STOP-BANG（+BMI、年龄、颈围（NC）和性别）。诸如STOP-BAG2等新型筛查工具可能改善OSA风险分层，但OSA工具在大型AWE人群中的有效性和性能特征尚未得到研究。
方法： 我们分析了724名在多导睡眠图（PSG）1年内有STOP-BANG数据的AWE。主要结局是呼吸暂停低通气指数（AHI）≥5。我们比较了STOP、STOP-BANG、STOP-BAG、STOP-BAG2和重新加权的STOP-BANG2。估计了敏感性、特异性、阳性预测值、阴性预测值和曲线下面积（AUC）。通过AUC差异比较工具性能，通过约登指数确定最佳截断值，并使用1,000次bootstrap重采样进行内部验证。使用利物浦癫痫严重程度量表评估癫痫严重程度和频率。
结果： 较高的STOP、STOP-BANG、STOP-BAG和STOP-BAG2评分与AHI≥5相关。STOP-BANG、STOP-BAG、STOP-BAG2和STOP-BANG2优于STOP。STOP-BAG2和STOP-BANG2显示出最强的预测能力，AUC均为0.70。在约登截断值下，STOP-BAG2的敏感性为67%，特异性为65%，而STOP-BANG2的敏感性为72%，特异性为60%。STOP-BAG2优于STOP-BANG和STOP-BAG（分别为p=0.003和p=0.001），与STOP-BANG2无差异（p=0.84）。
结论： STOP衍生工具对PSG定义的OSA显示出有限至中等的区分能力。连续加权模型具有最高的AUC，但相对于分类评分的增益不大，且其选择的截断值会漏掉临床上相关部分的OSA病例。

英文摘要

RATIONALE: Obstructive Sleep Apnea (OSA) is a highly prevalent, but often overlooked comorbidity in adults with epilepsy (AWE). Screening instruments widely used in general populations include STOP (Snoring, Tiredness, Observed apneas, high blood Pressure) and STOP-BANG (+BMI, Age, Neck circumference (NC), and Gender). Novel screens such as STOP-BAG2 may improve OSA risk stratification, but validity and performance characteristics of OSA instruments have not been studied in large AWE populations.
METHODS: We analyzed 724 AWE with STOP-BANG data available within 1 year of polysomnography (PSG). The primary outcome was apnea-hypopnea index (AHI) ≥ 5. We compared STOP, STOP-BANG, STOP-BAG, STOP-BAG2, and reweighted STOP-BANG2. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) were estimated. Instrument performance was compared by differences in AUC, with optimal cutoffs identified by the Youden index and internally validated using 1,000 bootstrap resamples. Seizure severity and frequency were assessed with the Liverpool Seizure Severity Scale.
RESULTS: Higher STOP, STOP-BANG, STOP-BAG, and STOP-BAG2 scores were associated with AHI ≥ 5. STOP-BANG, STOP-BAG, STOP-BAG2, and STOP-BANG2 were superior to STOP. STOP-BAG2 and STOP-BANG2 showed the strongest predictive power, each with an AUC of 0.70. At the Youden cutoff, STOP-BAG2 yielded 67 % sensitivity and 65 % specificity, while STOP-BANG2 yielded 72 % sensitivity and 60 % specificity. STOP-BAG2 was superior to STOP-BANG and STOP-BAG (p = 0.003 and p = 0.001, respectively) and did not differ from STOP-BANG2 (p = 0.84).
CONCLUSIONS: STOP-derived instruments showed limited-to-moderate discrimination for PSG-defined OSA. The continuous weighted models had the highest AUCs, but the gain over categorical scores was modest, and their selected cutoffs would miss a clinically relevant portion of OSA cases.