Validacija standardizovanih upitnika za procenu sindroma poremećaja disanja tokom spavanja

Abstract

Poremećaji disanja tokom spavanja (Sleep disordered breathing – SDB) obuhvataju spektar bolesti koje nastaju usled povećanog otpora u gornjem disajnom putu i reflektuje se na spavanje. Najveća podgrupa SDB su prekidi disanja tokom spavanja ili sleep apnea sindrom (Sleep Apnea Syndrome – SAS). SDB su prisutni kod 20% opšte populacije, dok je 82% muškaraca i 93% žena koje imaju umerenu i tešku OSA nedijagnostikovano. Kako osnovna dijagnostička metoda, polisomnografija, zahteva stručan kadar i adekvatnu laboratorijsku opermu nameće se potreba za brzom, efikasnom i jeftinom skrining metodom pri dijagnostici SAS. Cilj ove studije jeste da se uradi validacija i prevođenje “STOP BANG“ upitnika sa engleskog na srpski jezik i utvrdi njegova specifičnost i senzitivnost u odnosu na vrednosti AHI indeksa kod odraslih ispitanika pri dijagnostikovanju SAS i da se utvrdi senzitivnost i specifičnost “STOP BANG“ upitnika i Epfortove skale pospanosti zajedno. Istraživanje je u potpunosti sprovedeno u Centru za patofiziologiju disanja sa medicinom sna Instituta za plućne bolesti Vojvodine, Sremska Kamenica. Studijsku grupa se sastojala od 102 ispitanika koji su popunjavali oba upitnika, a potom je svima urađena polisomnografija. Testiranje „STOP BANG“ upitnikom, kao i retest nakon mesec dana uradilo 30 ispitanika. Rezultati istraživanja pokazuju da su u uzorku dominirale osobe muškog pola 69,6%. Prosečna starost je iznosila 50,1±13,8 godina. Najveći broj ispitanika je imao poremećaj disanja tokom spavanja (73,5%). Prema stepenu težine najveći broj ispitanika (30,4%) je bolovao od teškog oblika (apnea/hipopnea indeks- AHI>30), a prema tipu poremećaja dominirali su opstruktivni poremećaji sa 66,7% u ukupnom uzorku. Prekomerna dnevna pospanost, merena Epfortovom skalom pospanosti, bila je prisutna kod 58,8% ispitanika i korelirala je sa stepenom težine poremećaja (r=0,43). Dobijena senzitivnost i specifičnost za „STOP BANG“ upitnik je iznosila 62,7% i 51,9% respektivno. „STOP BANG“ upitnik je preveden na srpski jezik, a zatim je urađen test i retest upitika gde nije bilo razlike u odgovorima. Dobijena je granična vrednost za „STOP BANG“ upitnik koja iznosi 4.5, a senzitivnost i specifičnost testa za različit stepen težine SAS je zadovoljavajuća i iznosila je 70,7%/66,7% za laku, 78,6% /60,9% za umerenu i 87,4%/ 50,7% za tešku sleep apneu. Pri poređenju oba upitnika zajedno dobijena je bolja specifičnost 85,2%, 76,1%, 69,0% ali lošija senzitivnost 53,3%, 58,9% ,71,0% za laku , umerenu i tešku sleep apneu respektivno u grupi ispitanika koji su imali vrednosti oba upitnika iznad graničnih vrednosti. U grupi ispitanika gde je jedan od upitnika imao vrednosti iznad granične vrednosti dobijena je bolja senzitivnost ali lošija specifičnost u odnosu na samo „STOP BANG“ upitnik. Istraživanjem je utvrđen skrining metod -“STOP BANG“ upitnik, koji stratifikuje pacijente na osnovu kliničkih simptoma, fizičkog pregleda i prisustva faktora rizika, na one pacijente sa visokim rizikom kojima treba hitno uraditi polisomnografiju i uputiti ih dalje na lečenje i na one kojima polisomnografija nije potrebna.

Sleep disordered breathing (SDB) includes a spectrum of diseases occurring due to an increased resistance in the upper airway, which affects sleeping. The major SDB subgroup is sleep apnea syndrome (SAS). SDB is present in 20% of the general population, and among the subjects with a moderate or severe SAS, 82% of males and 93% of females remain undiagnosed. Since polysomnography - the basic diagnostic method, requires a well-trained staff and adequate laboratory equipment, the need for a fast, efficient and cheap screening method in the diagnosis of SAS has breen imposed. Objectives of the study are to evaluate and translate the “STOP BANG“ questionnaire from English to Serbian, establish its specificity and sensitivity in relation to the apnea hypopnea index (AHI) values while diagnosing SAS in adults, and to assess the cumulative sensitivity and specificity of the “STOP BANG“ questionnaire and Epworth Sleepiness Scale. The investigation has been entirely carried out in the Lung Function and Sleep Medicine Centre of the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. The study cohort included 102 subjects who were all, having answered both questionnaires first, submitted to polysomnography. Thirty subjects were tested by the „STOP BANG“ questionnaire, and retested a month later. Results of the investigation show the male sex predominated in the study sample (69.6%). The subjects' mean age was 50.1±13.8 years. Most subjects had SDB (73.5%). The majority of ther subjects (30.4%) had a serious SDB form (AHI>30). Obstuctive disorders prevailed, registered in 66.7% of the study population. Excessive daily sleepiness, measured by the Epworth sleepiness scale, was registered in 58.8% of the examined subjects, correlating well to the disorder severity level (r=0.43). Sensitivity and specificity obtained for the „STOP BANG“ questionnaire amounted to 62.7% and 51.9% respectively. The „STOP BANG“ questionnaire was translated to Serbian first, followed by testing an retesting using the questionairre, providing no differences in the obtained answeres. The obtained cut-off value for the „STOP BANG“ questionnaire was 4.5, and the test sensitivity and apecificity for different SAS severity levels were satisfactory, amounting to 70.7%/66.7% for mild, 78.6% /60,9% for moderate, and 87.4%/50.7% for severe sleep apnea. The cumulative comparation of the two questionnaires has disclosed a better specificity of 85.2%, 76.1%, and 69.0%, but a worse sensitivity of 53.3%, 58.9%, and 71.0% for a mild, moderate and severe sleep apnea respectively in the group of subjects whose values for both questionnaires exceeded the cutoffs. In the group of subjects with one of the questionnaire values exceeding the cutoffs, a better sensitivity but a worse specificity were obtained related to only the „STOP BANG“ questionnaire. The investigation has established the screening method – the “STOP BANG“ questionnaire which (on the basis of the clinical symptoms, physical examination and present risk factors) stratifies the patients into the high risk group requiring urgent polysomnography and referral for further treatment, and to those requiring no polysomnography.