Derivation and Validation of a Simple Perioperative Sleep Apnea Prediction Score

被引:89
|
作者
Ramachandran, Satya Krishna [1 ]
Kheterpal, Sachin [1 ]
Consens, Flavia [2 ]
Shanks, Amy [1 ]
Doherty, Tara M. [1 ]
Morris, Michelle [1 ]
Tremper, Kevin K. [1 ]
机构
[1] Univ Michigan, Univ Hosp, Dept Anesthesiol, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Univ Hosp, Dept Neurol, Ann Arbor, MI 48109 USA
来源
ANESTHESIA AND ANALGESIA | 2010年 / 110卷 / 04期
关键词
MORBIDLY OBESE-PATIENTS; ASSOCIATION; QUESTIONNAIRE; OBSTRUCTION; HYPOXEMIA; DIFFICULT; SURGERY; DEATH; TESTS;
D O I
10.1213/ANE.0b013e3181d489b0
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BACKGROUND: Obstructive sleep apnea (OSA) is a largely underdiagnosed, common condition, which is important to diagnose preoperatively because it has implications for perioperative management. Our purpose in this study was to identify independent clinical predictors of a diagnosis of OSA in a general surgical population, develop a perioperative sleep apnea prediction (P-SAP) score based on these variables, and validate the P-SAP score against standard overnight polysomnography. METHODS: A retrospective, observational study was designed to identify patients with a known diagnosis of OSA. Independent predictors of a diagnosis of OSA were derived by logistic regression, based on which prediction tool (P-SAP score) was developed. The P-SAP score was then validated in patients undergoing overnight polysomnography. RESULTS: The P-SAP score was derived from 43,576 adult cases undergoing anesthesia. Of these, 3884 patients (7.17%) had a documented diagnosis of OSA. Three demographic variables: age >43 years, male gender, and obesity; 3 history variables: history of snoring, diabetes mellitus Type 2, and hypertension; and 3 airway measures: thick neck, modified Mallampati class 3 or 4, and reduced thyromental distance were identified as independent predictors of a diagnosis of OSA. A diagnostic threshold P-SAP score showed excellent sensitivity (0.939) but poor specificity (0.323), whereas for a P-SAP score sensitivity was poor (0.239) with excellent specificity (0.911). Validation of this P-SAP score was performed in 512 patients with similar accuracy. CONCLUSION: The P-SAP score predicts diagnosis of OSA with dependable accuracy across mild to severe disease. The elements of the P-SAP score are derived from a typical university hospital surgical population. (Anesth Analg 2010;110:1007-15)
引用
收藏
页码:1007 / 1015
页数:9
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