NECK CIRCUMFERENCE AND OTHER CLINICAL-FEATURES IN THE DIAGNOSIS OF THE OBSTRUCTIVE SLEEP-APNEA SYNDROME
NECK CIRCUMFERENCE AND OTHER CLINICAL-FEATURES IN THE DIAGNOSIS OF THE OBSTRUCTIVE SLEEP-APNEA SYNDROME
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DOI：
10.1136/thx.47.2.101
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发表时间：
1992-02-01
期刊：
影响因子：
10
通讯作者：
STRADLING, JR
中科院分区：
文献类型：
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作者：
DAVIES, RJO;ALI, NJ;STRADLING, JR
颈围被认为比一般肥胖更能预测阻塞性睡眠呼吸暂停，但这一结论的统计有效性受到质疑。结合颈围与其他体征和症状，可使临床诊断或排除睡眠呼吸暂停有合理的信心。本研究探讨了这些问题。方法150例睡眠相关呼吸障碍患者填写调查问卷，调查内容包括白天嗜睡、打鼾、驾驶和鼻腔疾病。测量体重指数和经身高校正的颈围，并将阻塞性睡眠呼吸暂停严重程度量化为每小时多导睡眠图中动脉氧饱和度（SaO2）下降超过4%的次数。回顾性地使用多元线性回归来确定Sao2下降率的独立预测因子，然后在另外85名受试者中对推导的模型进行前瞻性检验。结果回顾性分析显示，“你是否在白天入睡，尤其是在不忙的时候？”是SaO2下降率方差的最佳预测因子（r2 = 0.13）；没有其他问题能改善这种相关性。该分析还显示，身体质量指数和任何问卷变量都不能改善由身高校正后的颈围单独解释的方差量（r2 = 0.35）。统计学上类似的前瞻性分析证实了这一关系（r2 = 0.38）。结论：对这些有睡眠呼吸暂停症状的睡眠门诊患者的前瞻性研究表明，颈围校正身高比一般肥胖更能预测阻塞性睡眠呼吸暂停。调查问卷的所有变量都没有增加其预测能力，但仅凭睡眠研究不足以避免诊断这种疾病的需要。
Background Neck circumference has been suggested to be more predictive of obstructive sleep apnoea than general obesity, but the statistical validity of this conclusion has been questioned. Combining neck circumference with other signs and symptoms may allow the clinical diagnosis or exclusion of sleep apnoea to be made with reasonable confidence. This study examines these issues.Methods One hundred and fifty patients referred to a sleep clinic for investigation of sleep related breathing disorders completed a questionnaire covering daytime sleepiness, snoring, driving, and nasal disease. Body mass index and neck circumference corrected for height were measured and obstructive sleep apnoea severity was quantified as number of dips in arterial oxygen saturation (SaO2) of more than 4% per hour of polysomnography. Multiple linear regression was used retrospectively to identify independent predictors of Sao2 dip rate, and the model derived was then prospectively tested in a further 85 subjects.Results The retrospective analysis showed that the question "Do you fall asleep during the day, particularly when not busy?" was the best questionnaire predictor of variance in the SaO2 dip rate (r2 = 0.13); no other question improved this correlation. This analysis also showed that neither body mass index nor any of the questionnaire variables improved the amount of variance explained by height corrected neck circumference alone (r2 = 0.35). A statistically similar prospective analysis confirmed this relationship (r2 = 0.38).Conclusions Prospective study of these patients referred to a sleep clinic with symptoms suggesting sleep apnoea shows that neck circumference corrected for height is more useful as a predictor of obstructive sleep apnoea than general obesity. None of the questionnaire variables examined add to its predictive power, but alone it is inadequate to avoid the need for sleep studies to diagnose this disease.