Predicting Severe Obstructive Sleep Apnea Syndrome in Adult Taiwanese Males with Excessive Daytime Sleepiness: A Prospective Observational Study

過度嗜睡之台灣成年男性患有重度阻塞性睡眠呼吸中止症候群之預測因子：一個前瞻性觀察研究

沈志浩(Chih-Hao Shen) ； 孟繁俊(Fan-Chun Meng) ； 彭忠衎(Chung-Kan Peng) ； 陳健文(Chien-Wen Chen) ； 簡志峯(Chih-Feng Chian) ； 彭萬誠(Wann-Cherng Perng) ； 吳世偉(Shih-Wei Wu)

《胸腔醫學》 31卷2期 (2016/04) Pp. 67-76

摘要

研究目的：過度嗜睡為阻塞性睡眠呼吸中止症候群重要症狀。本研究目的為找尋過度嗜睡之成年台灣男性患有重度阻塞性睡眠呼吸中止症候群（severe OSAS）之預測因子。研究方法：本研究為前瞻性觀察研究，共連續評估135位本院就診之成年台灣男性，招收其中Epworth Sleepiness Scale大於10分者，分為severe OSAS（AHI ≥ 30）及non- severe OSAS（AHI ＜ 30）兩組，並收集病患之臨床參數加以分析。研究結果：共88病患加入研究，severe OSAS組有45人。體重，身體質量指數（BMI），頸圍，腰圍，臀圍，腰臀比，胃食道逆流，肺總容積百分比在兩組間有明顯統計差異。以多變項邏輯式分析，BMI對severe OSAS為獨立預測因子。結論：BMI可作為出現過度嗜睡之成年台灣男性是否患有severe OSAS 之預測因子。

關鍵字

過度嗜睡 ； 阻塞性睡眠呼吸中止症候群 ； 身體質量指數

並列摘要

Purpose: Patients with severe obstructive sleep apnea syndrome (OSAS) are associated with greater risks of mortality and morbidity. Excessive daytime sleepiness (EDS) is the major complaint of patients with OSAS. The objective of this study was to identify the predictors for severe OSAS in adult Taiwanese males presenting with EDS. Materials and Methods: This was a prospective observational study of 135 consecutive adult males visiting our center. Patients with an Epworth Sleepiness Scale (ESS) score ＞ 10 were enrolled and divided into 2 groups: a severe OSAS group, consisting of patients with an apnea-hypopnea index (AHI) ≥ 30, and a non-severe OSAS group, consisting of patients with an AHI ＜ 30. Demographic and clinical data of the 2 groups were extracted for analysis. Results: A total of 88 patients were enrolled in the study. There were 45 patients (51.1%) in the severe OSAS group. Increased body weight, body mass index (BMI), neck, waist, and hip circumferences, waist/hip ratio, and co-existing gastroesophageal reflux disease were statistically significant factors in the severe OSAS group (p＜0.05). Increased total lung capacity % was statistically significant in the non-severe OSAS group (p＜0.05). In the multivariate analysis, BMI was an independent factor for severe OSAS (odds ratio, 1.302; 95% confidence interval, 1.017-1.667; p=0.037). Using area under the receiver operating characteristic (ROC) curve, BMI had an acceptable discriminatory power in predicting severe OSAS (area under the ROC curve: 0.774, sensitivity: 0.733; 1-specificity: 0.814). The cut-off point for BMI in detecting severe OSAS was 27.575 kg/m^2. Conclusions: BMI was a predictor for severe OSAS in adult Taiwanese males with EDS. Local clinicians should be able to use this predictor to decide whether referral for polysomnography is mandatory.

並列關鍵字

obstructive sleep apnea syndrome ； excessive daytime sleepiness ； body mass index