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目的 探讨基于颈动脉超声参数建立阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患病的Nomogram预测模型。方法 选取2023年5月至2024年5月收治的195例疑似OSAHS患者进行横断面研究，根据诊断结果分为OSAHS组（n=120）和单纯鼾症组（n=75）。比较两组入院时一般资料、颈动脉超声参数，应用Lasso-logistic回归分析OSAHS患病的影响因素，根据影响因素建立OSAHS患病的Nomogram预测模型，应用受试者工作特征（ROC）曲线、决策曲线分析（DCA）曲线评价模型的应用价值。结果 OSAHS组男性占比、体质量指数、颈围、腰围、臀围、吸烟史占比、糖尿病占比、高盐饮食占比、维生素D缺乏占比、埃普沃思嗜睡量表(ESS)评分、STOP-Bang问卷评分高于单纯鼾症组（P<0.05）;OSAHS组颈动脉内膜中层厚度（CIMT）、僵硬度系数β、脉搏波传导速度（PWV）高于单纯鼾症组，血管扩张度（VE）、顺应性系数（CC）低于单纯鼾症组（P<0.05）；经Lasso-logistic回归分析显示，性别、颈围、吸烟史、维生素D缺乏、STOP-Bang问卷评分、CIMT、β、PWV是OSAHS患病的独立危险因素，VE、CC是其独立保护因素（P<0.05,P<0.01）；基于上述相关影响因素所构建的OSAHS患病Nomogram预测模型的曲线下面积为0.941(95%CI:0.908,0.974),DCA曲线显示该模型具有较好的临床效用；风险等级分层显示，风险等级越高，复发风险越大（P<0.01）。结论 OSAHS患病的独立危险因素为性别、颈围、吸烟史、维生素D缺乏、STOP-Bang问卷评分、CIMT、β、PWV，保护因素为VE、CC，基于此构建的OSAHS患病风险预测模型敏感度高，能精准筛选出潜在的高风险人群，便于临床防治策略的制定。
Abstract：Objective To investigate a Nomogram prediction model for obstructive sleep apnea hypopnea syndrome(OSAHS) based on carotid ultrasound parameters. Methods A cross-sectional study was conducted on 195 patients with suspected OSAHS admitted from May 2023 to May 2024. According to the diagnosis results, they were divided into OSAHS group(n=120) and simple snoring group(n=75). The general data and carotid ultrasound parameters of the two groups at admission were compared. Lasas-logistic regression was used to analyze the influencing factors of OSAHS, and a Nomogram prediction model for OSAHS was established according to the influencing factors. The receiver operating characteristic(ROC) curve and decision curve analysis(DCA) were used to evaluate the application value of the model.Results Compared with the simple snoring group, the OSAHS group had a significantly higher proportion of males, body mass index(BMI), neck circumference, waist circumference, hip circumference, smoking history, diabetes, high-salt diet,vitamin D deficiency, Epvoth sleepiness scale(ESS) score and STOP-Bang questionnaire score(P<0.05). Compared with the simple snoring group, the OSAHS group had significantly higher carotid intima-media thickness(CIMT), stiffness coefficient β and pulse wave velocity(PWV) and significantly lower vascular ectasias(VE) and compliance coefficient(CC)at admission(P<0.05). Lasso-logistic regression analysis showed that gender, neck circumference, smoking history, vitamin D deficiency, STOP-Bang questionnaire score, CIMT, β and PWV were independent risk factors for OSAHS, and VE and CC were independent protective factors(P<0.05, P<0.01). The area under the curve of the Nomogram prediction model for OSAHS based on the above related influencing factors was 0.941(95%CI: 0.908, 0.974), and DCA showed that the model had good clinical utility. Risk stratification showed that the higher the risk level, the greater the risk of recurrence(P<0.01).Conclusion The independent risk factors of OSAHS are gender, neck circumference, smoking history, vitamin D deficiency, STOP-Bang questionnaire score, CIMT, β and PWV, and the protective factors are VE and CC. The risk prediction model of OSAHS based on these factors is highly sensitive and can accurately screen out potential high-risk population, facilitating the formulation of clinical prevention and treatment strategies.
[1] IANNELLA G, MAGLIULO G, GRECO A, et al. Obstructive sleep apnea syndrome:from symptoms to treatment[J].Int J Environ Res Public Health, 2022,19(4):2459.
[2] RAHMAN Z, NAZIM A, MROKE P, et al. Long-term management of sleep apnea-hypopnea syndrome:efficacy and challenges of continuous positive airway pressure therapy:a narrative review[J].Med Sci(Basel), 2024,13(1):4.
[3]冯剑,许爱国,李赛赛,等.阻塞性睡眠呼吸暂停患者颈动脉内膜中层厚度进展的相关因素分析[J].临床肺科杂志,2022,27(5):658-664.
[4] MELIANTE P G, ZOCCALI F, CASCONE F, et al. Molecular pathology, oxidative stress, and biomarkers in obstructive sleep apnea[J].Int J Mol Sci, 2023,24(6):5478.
[5] LEE J J, SUNDAR K M. Evaluation and management of adults with obstructive sleep apnea syndrome[J].Lung, 2021,199(2):87-101.
[6]陈李清.基于超声检查在阻塞性睡眠呼吸暂停患者上气道的形态学研究及其联合预测诊断OSA的价值评估[D].合肥：安徽医科大学,2022.
[7]中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.成人阻塞性睡眠呼吸暂停基层诊疗指南(2018年)[J].中华全科医师杂志,2019,18(1):21-29.
[8] CHOI J H, LEE K A, MOON J H, et al. 2023 clinical practice guidelines for diabetes mellitus of the korean diabetes association[J].Diabetes Metab J, 2023,47(5):575-594.
[9] JONES N R, MCCORMACK T, CONSTANTI M, et al.Diagnosis and management of hypertension in adults:NICE guideline update 2019[J].Br J Gen Pract, 2020,70(691):90-91.
[10] YAMAGISHI M, TAMAKI N, AKASAKA T, et al. JCS 2018guideline on diagnosis of chronic coronary heart diseases[J].Circ J,2021,85(4):402-572.
[11] SINNING D, LANDMESSER U. ECS guidelines 2016:dyslipidaemias[J].Herz, 2016,41(8):671-676.
[12] HSIEH P S, HWANG S W, HWANG S R, et al. Association between various breathing indexes during sleep and the Epworth Sleepiness Scale score in adults[J].Medicine(Baltimore),2022,101(48):e32017.
[13] SALIM S A, SHAH J, BWIKA J, et al. Stop-bang questionnaire for screening obstructive sleep apnea syndrome among hypertensive patients in Kenya[J].BMC Pulm Med, 2023,23(1):321.
[14] SCHWARTZ A R, JACOBOWITZ O, EISELE D W, et al.Targeted hypoglossal nerve stimulation for patients with obstructive sleep apnea:a randomized clinical trial[J].JAMA Otolaryngol Head Neck Surg, 2023,149(6):512-520.
[15] READ N, JENNINGS C, HARE A. Obstructive sleep apnoeahypopnoea syndrome[J].Emerg Top Life Sci, 2023,7(5):467-476.
[16] TAWARANURAK K, KAMOLPHIWONG S, SAE-WONG S,et al. Validity of a new prediction model to identify patients at risk for obstructive sleep apnea hypopnea syndrome[J].Ear Nose Throat J, 2023,102(1):52-57.
[17]黄志红,郭伟强,危香莲,等.Hcy联合颈动脉超声在脑卒中高危人群OSAHS筛查中的作用[J].中国动脉硬化杂志,2019,27(8):690-693,717.
[18] FIETZE I, LAHARNAR N, OBST A, et al. Prevalence and association analysis of obstructive sleep apnea with gender and age differences:results of SHIP-trend[J].J Sleep Res, 2019,28(5):e12770.
[19] BONSIGNORE M R, SAARESRANTA T, RIHA R L. Sex differences in obstructive sleep apnoea[J].Eur Respir Rev, 2019,28(154):190030.
[20] LAGARES L S, LINO R S, BOMFIM E S, et al. Anthropometric measures for the prognosis of obstructive sleep apnea in obese[J].Clin Med Res, 2022,20(3):147-152.
[21] VILMA FIDéLIS-DA SILVA L, HENRIQUE KIEMLE-TRINDADE S, NOEL MARZANO-RODRIGUES M, et al. Obstructive sleep apnea in adults with treacher collins syndrome is related with altered anthropometric measurements, increased blood pressure and impaired quality of life[J].Sleep Sci, 2023,16(2):139-147.
[22] MIHAICUTA S, UDRESCU L, UDRESCU M, et al. Analyzing neck circumference as an indicator of CPAP treatment response in obstructive sleep apnea with network medicine[J].Diagnostics(Basel), 2021,11(1):86.
[23] LI Y, MIAO Y, TAN J, et al. Association of modifiable risk factors with obstructive sleep apnea:a mendelian randomization study[J].Aging(Albany NY), 2023,15(23):14039-14065.
[24] HWANG M, NAGAPPA M, GULUZADE N, et al. Validation of the STOP-Bang questionnaire as a preoperative screening tool for obstructive sleep apnea:a systematic review and meta-analysis[J].BMC Anesthesiol, 2022,22(1):366.
[25] TOBUSHI T, FLORAS J S. Sleep apnea, autonomic disturbances, and blood pressure variability[J].Hypertension, 2024,81(9):1837-1844.
[26] YOU M, ZHANG L, FANG L, et al. Evaluation of carotid arterial elasticity in patients with obstructive sleep apnea hypopnea syndrome by two-dimensional speckle tracking imaging[J].Medicine(Baltimore), 2017,96(51):e8817.
[27]张涛,余琼,袁外,等.老年阻塞性睡眠呼吸暂停低通气综合征患者颈动脉弹性与氧化应激反应的关系[J].中国耳鼻咽喉头颈外科,2022,29(4):259-262,267.
基本信息:
DOI：
中图分类号:R766;R445.1
引用信息:
[1]陈平,王晖,肖海燕等.基于颈动脉超声参数建立阻塞性睡眠呼吸暂停低通气综合征患病的Nomogram预测模型[J].临床误诊误治,2025,38(12):38-43.
基金信息:
河北省医学科学研究课题计划（20220311）; 沧州市科技计划自筹经费项目（222106111）