| Objective:To assess the accuracy of the STOP-Bang questionnaire(SBQ)about screening for obstructive sleep apnea hypopnea syndrome(OSAHS)in adults,and to establish appropriate cutoffs for body mass index,neck circumference,age,and SBQ score for this population in combination with the body size characteristics of the study subjects,and to evaluate the accuracy of the SBQ for combined screening with waist to height ratio(WHt R).Methods:The data were collected from October,2019 to November,2020 at The Affiliated Hospital of Guizhou Medical University with suspected OSAHS.The minimum sample size was about 154 cases,and 218 cases were included in this study,all of them completed the SBQ and underwent overnight polysomnography(PSG).SBQ screening and PSG were tested in a blinded concurrent manner.The study subjects were divided into a diseased group with moderate severe OSAHS and a non diseased group based on apnea hypopnea index(AHI).According to SBQ screening results,the subjects were divided into a positive group with moderate severe OSAHS and negative group.And calculated in the form of four-fold table,the optimal cutoffs were determined by adjusting age,body mass index(BMI),neck circumference(NC),and SBQ score cutoffs,and calculating the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),Youden index,and area under the receiver operating characteristic curve(ROC).And the modified version of SBQ was combined with WHt R for joint diagnosis to evaluate the accuracy of combined screening.Results:With all 218 patients completing the experiment,159(72.94%)were in the moderate severe group.The original SBQ had a sensitivity of 93.71%,specificity of47.46%,PPV of 82.80%,NPV of 73.70%,Youden index of 0.41,and area under the ROC curve(AUC)of 0.71 for predicting moderate severe OSAHS.Downregulation of the age cutoff alone did not improve questionnaire screening efficacy.Adjusting for age and BMI cutoffs simultaneously,questionnaire screening efficacy was highest at an age cutoff of 50 years and a BMI cutoff of 30 kg/m~2.The questionnaire screening efficacy was not improved by downregulating the neck circumference cut-off value in the female population,and was highest at the NC cut-off value of 40cm in the overall population.Using the modified version of the SBQ(BMI>30kg/m~2,NC>40cm,age>50 years)had a sensitivity of 95.60%,specificity of47.46%,PPV of 83.10%,NPV of 80.00%,Youden index of 0.43,and AUC of 0.72for predicting moderate severe OSAHS.When the modified SBQ score used“≥4”as the cutoff value,the highest Youden index and AUC were 0.54,0.77 respectively.When the modified SBQ≥3 points were combined with WHt R>0.55,the highest Youden index and AUC were 0.58,0.79 respectively.Conclusions:SBQ is effective in screening for moderate severe OSAHS and better screening accuracy can be achieved by using a modified version of the SBQ(BMI>30 kg/m~2,NC>40 cm,age>50 years),and the value of"30,40,50"is more convenient for clinical use.The maximum diagnostic accuracy can be achieved when the modified SBQ total score used“≥4”points as the cutoff.For patients with a modified SBQ total score“=3”points,which is recommended to be diagnosed jointly with WHt R,who fulfilled the modified SBQ score=3 points and WHt R>0.55 were considered at high risk for moderate severe OSAHS,and the modified version of SBQ can be a screening tool to identify moderate severe OSAHS. |
