Serum bikarbonat düzeyinin eklenmesinin obstrüktif uyku apnesi için Berlin uyku anketinin duyarlılık ve özgüllüğüne etkisi
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Tarih
2019
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Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Obstrüktif uyku apne sendromunun (OSAS) altın tanı standardı polisomnografidir (PSG) ve OSAS sınıflandırılması bir PSG verisi olan apne-hipopne indeksi (AHİ) ile yapılır. Bununla birlikte PSG nin pahalı ve zor uygulanabilir olması nedeni ile soru-cevap şeklinde hazırlanmış tarama testleri geliştirilmiştir. Bu testlerden birisi de akredite edilmiş bir tarama aracı olan Berlin anketidir (Berlin questionnaire). Berlin uyku anketinde, skor ? 2 olduğunda hasta OSAS açısından "yüksek riskli" kabul edilir. OSAS da gelişen apne vehipopneler, aralıklı hipoksiye yol açtığı gibi hiperkapniye de yol açar ve serum bikarbonat (HCO3) retansiyonu ile sonuçlanabilir. OSAS ın ağırlığını gösteren AHİ sınıflaması ilearteryel kan gazında bakılan serum HCO3değeri arasında bir korelasyon vardır.Buradan hareketle Berlin anketine serum HCO3değerinin eklenmesi ile anketin duyarlılığının arttırılabilmesi olasıdır.Bu çalışmada Berlin anketine serum HCO3 düzeyinin parametre olarak eklenmesinin,bu tarama testinin duyarlılığına olan olası etkisi incelenecektir. Materyal-Metot Prospektif olarak yürütülmüş olan çalışmamıza 31.10.2018 ile 30.04.2019 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Hastanesi Uyku Bozuklukları Merkezine yatan, çalışmaya katılmayı kabul eden hastalarımız dahil edildi. Bilinen KOAH ve bilinen rutin diyaliz hastaları çalışma dışında bırakıldı. Çalışma öncesinde Dicle Üniversitesi Tıp Fakültesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulundan onay alındı. Çalışmaya katılmayı kabul eden bütün hastalarımızdan çalışma öncesi bilgilendirilmiş onam alındı. Polisomnografi yapılacak hastalarımızdan işlem öncesi detaylı anamnez alındı. Hastalara Berlin Uyku Anketi ile OSAS varlığı açısından risk analizi yapıldı. Hastaların ayrıca Epworth Uykululuk Skalası ile gündüz aşırı uykululuk düzeyleri skorlandı. Hastalardan 5 dakika arayla iki defa istirahat tansiyon değerleri mm-Hg cinsinden ölçüldü, her iki ölçümün sistolik ve diyastolik tansiyon değerlerinin aritmetik ortalaması baz alındı. İşlem günü hastaların üzerlerinde ince bir elbise olacak şekilde kilogram cinsinden ağırlıkları ölçüldü. Hastaların boyları, bel çevreleri, boyun çevreleri santimetre cinsinden ölçüldü. Test sonrası poliklinik müracaatı önerilen hastalardan arteriyel kangazı çalışıldı, serum bikarbonat seviyesi, parsiyel oksijen basıncı, parsiyel karbondioksit basıncı, serum pH ve serum laktat değerleri ölçüldü. Berlin anketi skoru ve serum HCO3 seviyesi için kestirimci parametreler (duyarlılık, özgüllük, pozitif ve negatif prediktif değerler)hesaplandı. Çalışmaya dahil edilmiş olan 115 hasta kontrol kan değeri çalışılamadığı için, 32 hastada da uyku kalitesi yetersiz olduğu için çalışma dışında bırakıldı. Polisomnografi test sonuçlarına göre hastalar AHİ < 5/h = basit horlama, 5-15/h = hafif, 16-30/h= orta ve >30/h = ağır olarak gruplandırıldı. İstatistik verilerinin hesaplanmasında SPSS 22 programı kullanıldı. İstatistik anlamlılık p < 0.05 olarak kabul edildi. Bulgular Çalışmaya dahil edilen hastaların 193 (% 63,7) ü erkek 110(%36,3) u kadınlardan oluşmaktaydı. Katılımcılara uygulanan Berlin anketi sonucunda OSAS açısından katılımcıların 85 (% 28,1)i düşük riskli, 218(% 71,9) i yüksek riskli olarak bulundu. Tüm hastalar arasında Gündüz aşırı uykululuk hali (GAUH) 175(%57,8) hastada saptandı. OSAS pozitif hastalarda Epworth Uykululuk Ölçeği ortalama değerleri OSAS negatif hastalara göre daha yüksek çıktı ve istatistiksel olarak anlamlı bulundu. Tüm hastalar arasında 222 hasta OSAS olarak değerlendirildi ve çalışmamızda OSAS sıklığı %73,3 olarak değerlendirildi. Hastalarımızın 81 (%26,7) i basit horlama, 46(% 15,2) sı hafif OSAS, 52(% 17,2) si orta OSAS ve 124(% 40,9) ü ağır OSAS olarak değerlendirildi. Hastaların demografik özelliklerinin OSAS varlığı üzerinde etkileri incelendiğinde yaş, BKİ ve bel çevresi faktörlerine ek olarak ağırlığın da OSAS'lı hastalarda istatistiksel anlamlılık derecesinde daha yüksek olduğu gösterildi. Boy uzunluğu iki hasta grubu arasında önemli bir fark göstermedi. Hastaların arter kangazı sonuçlarının OSAS varlığı üzerinde etkileri incelendiğinde serum HCO3 değerinin OSAS'lı hastalarda istatistiksel anlamlılık derecesinde daha yüksek olduğu PaO 2'nin ise daha düşük olduğu gösterildi. pH, PaCO2 tüm hasta grupları ortalamaları baz alındığında iki hasta grubu arasında önemli bir fark bulunmadı. Hastaların polisomnografi ve arteryel kangazı sonuçları değerlendirildiğinde OSAS ağırlığı ile HCO3 seviyeleri arasında korelasyon olduğu görüldü Tüm hastalar baz alındığında Berlin anketinin OSAS hastalarını tespit etmedeki PPD, NPD ve özgüllüğü sırasıyla %94, %80 ve % 83,9, HCO3>24.94 değerinin üzerinde olan hastalarda Berlin anketinin PPD, NPD ve özgüllüğü sırasıyla %98,3, %23,5 ve %57,1 olarak ölçüldü. Benzer şekilde tüm hastalar baz alındığında Berlin anketinin ağır OSAS hastalarını tespit etmedeki PPD, NPD ve özgüllüğü sırasıyla %55,5, %96,7 ve % 46,1, HCO3>25.45 değerinin üzerinde olan hastalarda Berlin anketinin PPD, NPD ve özgüllüğü sırasıyla %73,4, %66,7 ve %9,5 olarak ölçüldü. Sonuç Serum HCO3değerinin eklenmesi, Berlin anketinin OSAS hastalarının tespit etmede duyarlılığını arttırır fakat özgüllüğünü azaltır. Yanlış negatif hastalar nedeniyle oluşan sağlık ve tedavi maliyetleri azalmış olur. Bu yaklaşım hekimlerin hastalarını OSAS için risklerine göre sınıflandırmalarını ve komplikasyonları en aza indirmek için uygun şekilde yönetmelerini sağlar.
The gold diagnostic standard for obstructive sleep apnea syndrome (OSAS) is polysomnography and OSAS classification is based on the apnea-hypopnea index (AHI), a PSG data. However, because PSG is expensive and difficult to perform, screening tests have been developed in the form of question and answer. One of these tests is the Berlin questionnaire, an accredited screening tool. In the Berlin questionnaire, when the score is ? 2, patient is considered ''high risk'' for the presence of OSAS. Apnea and hypopneas developing in OSAS cause intermittent hypoxia as well as hypercapnia and it may conclude retention of serum bicarbonate (HCO3). There is a correlation between the AHI classification indicating the severity of OSAS and the serum HCO3 value measured in arterial blood gas. Thus, it is possible to increase the sensitivity of the questionnaire by adding serum HCO3 value to the Berlin questionnaire. In this study, the possible effect of adding serum HCO3 level to the Berlin questionnaire as a parameter on the sensitivity of this screening test will be examined. Material and Method: This was a prospective study. All Patients who were admitted into sleep clinic of our hospital between 10.31.2018 to 04.30.2019 and accepted to participate were included in the study. Known COPD and routine dialysis patients were excluded. The study was approved by the Non-Interventional Clinical Trials Ethics Committee of Dicle University School of Medicine. Informed consent was obtained from all patients who agreed to participate in the study. A detailed history was taken from our patients who would be subject to polysomnography test on the day of the procedure. The patients were analyzed with the Berlin questionnaire for the risk of OSAS. Epworth Sleepiness Scale was also used to score excessive daytime sleepiness. The resting blood pressures were measured two times in mm-Hg with 5-minute intervals from the patients, and the arithmetic mean of these systolic and diastolic blood pressures were taken as basis. On the day of the procedure, the weight of the patients was measured in kilograms on a thin dress. The waist circumference and the neck circumference of the patients were measured in centimeters. After the test, arterial blood gas was studied from the patients who were admitted to the outpatient clinic. Serum bicarbonate level, partial oxygen pressure, partial carbon dioxide pressure, serum pH and serum lactate values were measured. Predictive parameters (sensitivity, specificity, positive and negative predictive values) were calculated for the Berlin questionnaire score and serum HCO3 level. 115 patients included in the study were excluded from the study because control blood values could not be studied and 32 patients were excluded because of poor sleep quality. According to polysomnography test results, patients were grouped as AHI <5 / h = simple snoring, 5-15 / h = mild, 16-30 / h = moderate and> 30 / h = severe. SPSS 22 program was used to calculate the statistical data. Statistical significance was accepted as p <0.05. Results: Of the patients included in the study, 193 (63.7%) were male and 110 (36.3%) were female. As a result of the Berlin questionnaire, 85 (28.1%) of the participants were found to be low risk and 218 (71.9%) of them were high risk in terms of OSAS. Among all patients, Daytime sleepiness was detected in 175 (57.8%) patients. Epworth Sleepiness Scale mean values were higher in OSAS positive patients than OSAS negative patients and it was found statistically significant. Among all patients, 222 patients were evaluated as OSAS and the frequency of OSAS was 73.3% in our study. 81 (26.7%) of our patients were evaluated as simple snoring, 46 (15.2%) were mild OSAS, 52 (17.2%) were moderate OSAS and 124 (40.9%) were severe OSAS. When the effects of demographic characteristics of the patients on the presence of OSAS were examined, it was shown that in addition to age, BMI and waist circumference, weight was also found to be higher in patients with OSAS. Height did not differ significantly between the two patient groups. When the effects of arterial blood gas results on the presence of OSAS were examined, it was shown that serum HCO3 value was higher in patients with OSAS and PaO2 was lower. On pH and PaCO2, no significant difference was found between the two patient groups, based on the average of all patient groups. When the PSG and arterial blood gas results of the patients were evaluated, a correlation was found between OSAS weight and HCO3 levels. The PPV, NPV and specificity of the Berlin sleep questionnaire in detecting OSAS patients were 94%, 80% and 83.9%, respectively, based on all patients. In patients with HCO3 > 24.94, PPV, NPV and specificity of the Berlin questionnaire were 98.3%, 23.5% and 57.1%, respectively. Similarly, based on all patients, PPV, NPV and specificity of the Berlin questionnaire in detecting severe OSAS patients were 55.5%, 96.7% and 46.1% respectively. PPV, NPV and specificity of the Berlin sleep questionnaire were 73.4%, 66.7% and 9.5%, respectively, in patients with HCO3 > 25.45. Conclusion: The addition of serum HCO3 increases the sensitivity of the Berlin questionnaire in detecting OSAS patients, but decreases its specificity. Health and treatment costs due to false negative patients are reduced. This approach allows physicians to classify patients according to their risks for OSAS and manage them appropriately to minimize complications.
The gold diagnostic standard for obstructive sleep apnea syndrome (OSAS) is polysomnography and OSAS classification is based on the apnea-hypopnea index (AHI), a PSG data. However, because PSG is expensive and difficult to perform, screening tests have been developed in the form of question and answer. One of these tests is the Berlin questionnaire, an accredited screening tool. In the Berlin questionnaire, when the score is ? 2, patient is considered ''high risk'' for the presence of OSAS. Apnea and hypopneas developing in OSAS cause intermittent hypoxia as well as hypercapnia and it may conclude retention of serum bicarbonate (HCO3). There is a correlation between the AHI classification indicating the severity of OSAS and the serum HCO3 value measured in arterial blood gas. Thus, it is possible to increase the sensitivity of the questionnaire by adding serum HCO3 value to the Berlin questionnaire. In this study, the possible effect of adding serum HCO3 level to the Berlin questionnaire as a parameter on the sensitivity of this screening test will be examined. Material and Method: This was a prospective study. All Patients who were admitted into sleep clinic of our hospital between 10.31.2018 to 04.30.2019 and accepted to participate were included in the study. Known COPD and routine dialysis patients were excluded. The study was approved by the Non-Interventional Clinical Trials Ethics Committee of Dicle University School of Medicine. Informed consent was obtained from all patients who agreed to participate in the study. A detailed history was taken from our patients who would be subject to polysomnography test on the day of the procedure. The patients were analyzed with the Berlin questionnaire for the risk of OSAS. Epworth Sleepiness Scale was also used to score excessive daytime sleepiness. The resting blood pressures were measured two times in mm-Hg with 5-minute intervals from the patients, and the arithmetic mean of these systolic and diastolic blood pressures were taken as basis. On the day of the procedure, the weight of the patients was measured in kilograms on a thin dress. The waist circumference and the neck circumference of the patients were measured in centimeters. After the test, arterial blood gas was studied from the patients who were admitted to the outpatient clinic. Serum bicarbonate level, partial oxygen pressure, partial carbon dioxide pressure, serum pH and serum lactate values were measured. Predictive parameters (sensitivity, specificity, positive and negative predictive values) were calculated for the Berlin questionnaire score and serum HCO3 level. 115 patients included in the study were excluded from the study because control blood values could not be studied and 32 patients were excluded because of poor sleep quality. According to polysomnography test results, patients were grouped as AHI <5 / h = simple snoring, 5-15 / h = mild, 16-30 / h = moderate and> 30 / h = severe. SPSS 22 program was used to calculate the statistical data. Statistical significance was accepted as p <0.05. Results: Of the patients included in the study, 193 (63.7%) were male and 110 (36.3%) were female. As a result of the Berlin questionnaire, 85 (28.1%) of the participants were found to be low risk and 218 (71.9%) of them were high risk in terms of OSAS. Among all patients, Daytime sleepiness was detected in 175 (57.8%) patients. Epworth Sleepiness Scale mean values were higher in OSAS positive patients than OSAS negative patients and it was found statistically significant. Among all patients, 222 patients were evaluated as OSAS and the frequency of OSAS was 73.3% in our study. 81 (26.7%) of our patients were evaluated as simple snoring, 46 (15.2%) were mild OSAS, 52 (17.2%) were moderate OSAS and 124 (40.9%) were severe OSAS. When the effects of demographic characteristics of the patients on the presence of OSAS were examined, it was shown that in addition to age, BMI and waist circumference, weight was also found to be higher in patients with OSAS. Height did not differ significantly between the two patient groups. When the effects of arterial blood gas results on the presence of OSAS were examined, it was shown that serum HCO3 value was higher in patients with OSAS and PaO2 was lower. On pH and PaCO2, no significant difference was found between the two patient groups, based on the average of all patient groups. When the PSG and arterial blood gas results of the patients were evaluated, a correlation was found between OSAS weight and HCO3 levels. The PPV, NPV and specificity of the Berlin sleep questionnaire in detecting OSAS patients were 94%, 80% and 83.9%, respectively, based on all patients. In patients with HCO3 > 24.94, PPV, NPV and specificity of the Berlin questionnaire were 98.3%, 23.5% and 57.1%, respectively. Similarly, based on all patients, PPV, NPV and specificity of the Berlin questionnaire in detecting severe OSAS patients were 55.5%, 96.7% and 46.1% respectively. PPV, NPV and specificity of the Berlin sleep questionnaire were 73.4%, 66.7% and 9.5%, respectively, in patients with HCO3 > 25.45. Conclusion: The addition of serum HCO3 increases the sensitivity of the Berlin questionnaire in detecting OSAS patients, but decreases its specificity. Health and treatment costs due to false negative patients are reduced. This approach allows physicians to classify patients according to their risks for OSAS and manage them appropriately to minimize complications.
Açıklama
Anahtar Kelimeler
Bikarbonat, Uyku apnesi, Obstrüktif uyku apnesi, Bicarbonate, Sleep apnea, Obstructive sleep apnea
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Dursun, M. (2019). Serum bikarbonat düzeyinin eklenmesinin obstrüktif uyku apnesi için Berlin uyku anketinin duyarlılık ve özgüllüğüne etkisi. Uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
