背景:阻塞性睡眠呼吸暂停(OSA)综合征与高死亡率相关,血氧指标在评价本病中具有重要作用。这项研究的目的是探讨血氧指标的价值,包括最低氧饱和度(LSpO2),氧还原指数(ODI)和氧饱和度低于90%(TS90%)的时间,作为OSA综合征的诊断标志物。
方法:在这项回顾性研究中,纳入2018年6月至2021年6月在宁波市第一医院接受治疗的320例OSA患者,分为轻度、中度,根据病情的严重程度(分别为n=104、92和124)。比较血氧指标和呼吸暂停低通气指数(AHI)。进行Spearman相关分析以探讨各参数之间的关系。建立受试者工作特征曲线,评价血氧指标对OSA综合征的诊断价值。
结果:体重有显著差异,身体质量指数,各组间睡眠前后血压及血压差异有统计学意义(P<0.05)。LSpO2水平遵循一种模式,严重组显示最低值,其次是温和组,然后是轻度组,而ODI和TS90%水平则相反(P<0.05)。Spearman相关分析表明,ODI,TS90%与OSA严重程度呈正相关,而LSpO2与OSA严重程度呈负相关。ODI对OSA具有较高的诊断价值(曲线下面积(AUC)=0.823,95%CI:0.730-0.917)。TS90%对OSA具有较高的诊断价值(AUC=0.872,95%CI:0.794-0.950)。LSpO2对OSA的诊断价值具有较高的准确性(AUC=0.716,95%CI:0.596-0.835)。3项指标的组合对OSA具有较高的诊断价值(AUC=0.939,95%CI:0.890-0.989)。发现组合特征的诊断价值明显高于单个指标的诊断价值(P<0.05)。
结论:对OSA严重程度的评估不应仅依靠单个观察指标,而是在ODI的组合上,LSpO2和TS90%。这种组合的诊断特征可以提供对患者病情的更全面评估,并作为替代诊断基础,以确保及时诊断和对OSA进行适当的临床治疗。
BACKGROUND: Obstructive sleep apnea (OSA) syndrome is associated with a high mortality, and blood oxygen indexes play an important role in evaluating this disease. The objective of this study was to explore the value of blood oxygen indexes, including minimum oxygen saturation (LSpO2), oxygen reduction index (ODI) and time spent with oxygen saturation below 90% (TS 90%), as diagnostic markers for OSA syndrome.
METHODS: In this retrospective study, 320 patients with OSA treated in Ningbo First Hospital from June 2018 to June 2021 were included and divided into mild, moderate, and severe groups according to the severity of the condition (n = 104, 92, and 124, respectively). The blood oxygen indexes as well as the apnea-hypopnea index (AHI) were compared. The Spearman correlation analysis was performed to explore the relationship between the parameters. Receiver operating characteristic curves were generated to evaluate the diagnostic value of the blood oxygen indexes for OSA syndrome.
RESULTS: There were significant differences in body weight, body mass index, and blood pressure before and after sleep among the groups (P < 0.05). LSpO2 levels followed a pattern with the severe group showing the lowest values, followed by the moderate group, and then the mild group, whereas ODI and TS 90% levels showed the opposite (P < 0.05). Spearman correlation analysis showed that AHI, ODI, TS 90% were positively correlated with severity of OSA, whereas LSpO2 was negatively correlated with severity of OSA. ODI showed a high diagnostic value for OSA (area under curve (AUC) = 0.823, 95% CI: 0.730-0.917). TS 90% showed a high diagnostic value for OSA (AUC = 0.872, 95% CI: 0.794-0.950). LSpO2 showed high accuracy in diagnostic value for OSA (AUC = 0.716, 95% CI: 0.596-0.835). The combination of the 3 indexes demonstrated a high diagnostic value for OSA (AUC = 0.939, 95% CI: 0.890-0.989). The diagnostic value of the combined signature was found to be significantly higher compared to the value of individual indexes (P < 0.05).
CONCLUSIONS: The evaluation of the severity of OSA should not rely solely on a single observation index, but rather on a combination of ODI, LSpO2 and TS 90%. This combined diagnostic signature can provide a more comprehensive assessment of the patient\'s condition and serve as an alternative diagnostic basis to ensure timely diagnosis and appropriate clinical treatment for OSA.