NoSAS评分中患者自行颈部环绕测量：三级睡眠中心的评分可获取性与诊断效能

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）患病率很高，早期识别仍是一项重大公共卫生挑战。NoSAS评分是一种简单且经过验证的筛查工具，其中包含颈围>40 cm。然而，在常规实践中颈围测量可能执行不一致。患者自行颈部环绕测量是一种无需设备、基于手部的操作，可能是一种实用的替代方法。
方法： 我们对前瞻性收集的常规临床数据进行了回顾性分析，纳入2025年9月至12月期间在法国里昂一家三级睡眠中心因疑似OSA转诊的449例连续患者。颈围和患者自行手动颈部环绕测量在同一解剖水平进行评估。针对呼吸暂停低通气指数（AHI）阈值≥15和≥30次·h-1评估诊断效能。将纳入患者自行颈部环绕测量的改良NoSAS评分（NoSAS hand）与标准评分进行比较。在配对完整病例比较中，诊断估计值和评分间差异以95%置信区间和McNemar检验报告。
结果： 患者自行颈部环绕测量的可获取性显著高于实测颈围（94.0% vs 71.3%），NoSAS hand的可计算频率也高于标准NoSAS（91.3% vs 68.8%）。在配对完整病例队列（n=305）中，在AHI≥15/h时，敏感度和特异度差异（NoSAS hand减去标准NoSAS）分别为0.0%（95% CI -1.9至1.9）和+1.0%（95% CI -2.0至5.1）；在AHI≥30/h时相应差异分别为0.0%（95% CI -2.5至2.5）和+0.5%（95% CI -1.6至2.7）。
结论： 患者自行颈部环绕测量是一种简单、无需设备的实测颈围替代方法，在保持诊断效能的同时显著提高了NoSAS实施的可行性。在该三级睡眠中心工作流程中，患者自行颈部环绕测量的记录频率高于实测颈围，并提高了NoSAS评分的可获取性；在AHI≥15/h和≥30/h时，两种评分之间的敏感度和特异度配对点估计差异很小。

英文摘要

BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent, and early identification remains a major public health challenge. The NoSAS score is a simple and validated screening tool, incorporating neck circumference >40 cm. However, neck circumference measurement may be inconsistently performed in routine practice. Patient-performed neck encirclement, an equipment-free hand-based maneuver, may represent a pragmatic alternative.
METHODS: We conducted a retrospective analysis of prospectively collected routine clinical data including 449 consecutive patients referred for suspected OSA in a tertiary sleep center (Lyon, France) between September and December 2025. Neck circumference and Patient-performed manual neck encirclement were assessed at the same anatomical level. Diagnostic performance was evaluated for apnea-hypopnea index (AHI) thresholds ≥15 and ≥30 events·h-1. A modified NoSAS score incorporating patient-performed neck encirclement (NoSAS hand) was compared with the standard score. In paired complete-case comparisons, diagnostic estimates and between-score differences were reported with 95% confidence intervals and McNemar tests.
RESULTS: Patient-performed neck encirclement was substantially more available than measured neck circumference (94.0% vs 71.3%) and NoSAS hand was calculable more often than standard NoSAS (91.3% vs 68.8%). In the paired complete-case cohort (n=305), at AHI ≥15/h, sensitivity and specificity differences (NoSAS hand minus standard NoSAS) were 0.0% (95% CI -1.9 to 1.9) and +1.0% (95% CI -2.0 to 5.1), respectively; corresponding differences at AHI ≥30/h were 0.0% (95% CI -2.5 to 2.5) and +0.5% (95% CI -1.6 to 2.7).
CONCLUSIONS: Patient-performed neck encirclement is a simple, equipment-free alternative to measured neck circumference that substantially improves the feasibility of NoSAS implementation while preserving diagnostic performance. In this tertiary sleep-centre workflow, patient-performed neck encirclement was recorded more often than measured neck circumference and increased NoSAS score availability; paired point estimates of sensitivity and specificity at AHI ≥15/h and ≥30/h differed little between scores.