Obstrüktif Uyku Apnesi Tanısında Epworth Uykululuk Ölçeğinin Ortak Değişkene Göre Düzeltilmiş İşlem Karakteristik Eğrisi ile Değerlendirilmesi

Öz

Amaç: Obstrüktif uyku apnesi OSA tanısında Epworth uykululuk ölçeğinin ESS başarısının değerlendirmesinde ortak değişken etkisinin araştırılması ve etkili ortak değişkenler için düzeltme yapılarak analiz edilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya Nisan 2016 - Ağustos 2016 tarihleri arasında Akdeniz Üniversitesi Kulak Burun Boğaz Hastalıkları Anabilim Dalı’ nda polisomnografi ile OSA tanısı konulan apne hipopne indeksi, AHİ >5 ve ESS anketi olan 340 hasta alınmıştır. ESS’ nin OSA tanısındaki başarısı AHİ ≥ 15 ve AHİ ≥ 30 olmak üzere iki farklı düzende incelenmiştir. Analizde klasik işlem karakteristik eğrisi İKE ve ortak değişken etkisi düzeltilmiş İKE analizi kullanılmıştır. Bulgular: Ortak değişken etki tahminleri tüm olası ortak değişkenlerin modele katıldığı İKE modeli ile incelendiğinde, diğer değişkenler de modeldeyken sadece boyun çevresinin anlamlı etkisi olduğu gözlenmiştir P

Anahtar Kelimeler

• Obstrüktif uyku apnesi, Epworth uykululuk ölçeği, İşlem karakteristik eğrisi

Covariate Adjusted Receiver Operating Characteristic Curve Analysis for the Evaluation of the Epworth Sleepiness Scale in Diagnosis of Obstructive Sleep Apnea

Öz

Objective: The purpose of this study was to investigate the effect of covariates in the diagnostic performance of the Epworth Sleepiness Questionnaire ESS in obstructive sleep apnea OSA and to analyze it by covariate adjusted analysis.Material and Methods: This retrospective cohort study enrolled 340 consecutive patients, who completed the ESS questionnaire, underwent complete polysomnographic evaluation and were diagnosed with OSA apnea hypopnea index, AHI >5 at our accredited sleep disorders center between April 2016 and August 2016. Diagnostic accuracy of ESS was evaluated for two different settings; AHI ≥ 15 and AHI ≥ 30. In the statistical analysis, classical receiver operating characteristic ROC curve and covariate adjusted ROC curve analyzes were used.results: In the ROC regression model, where all covariates were included, only the covariate effect of neck circumference was found statistically significant P

Anahtar Kelimeler

• Obstructive sleep apnea, Epworth sleepiness scale, Receiver operating characteristic curve

Kaynakça

1. 1. Malhotra A, White DP. Obstructive sleep apnoea. Lancet 2002; 360: 237-45.
2. 2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328:1230-5.
3. 3. Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991;14: 540-5.
4. 4. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK. Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American academy of sleep medicine. J Clin Sleep Med 2012; 8: 597–619.
5. 5. Karakoç O, Akçam T, Gerek M, Birkent H. Horlama ve obstrüktif uyku apneli hastalarda Epworth Uykululuk Skalasının güvenilirliği. KBB-Forum 2007; 6: 86-9.
6. 6. R Core Team. R: A language and environment for statistical computing. 2013 (http://www.R-project.org/).
7. 7. Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez JC, Müller M. pROC: An open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics. 2011; 12: 77.
8. 8. Rodriguez-Alvarez, MX, Roca-Pardinas J, CadarsoSuarez C. A new flexible direct ROC regression model - Application to the detection of cardiovascular risk factors by anthropometric measures. Computational Statistics and Data Analysis 2011; 5512: 3257–3270.

9. 9. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013; 177: 1006-14.
10. 10. Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology 2009; 110: 928-39.
11. 11. Eiseman NA, Westover MB, Mietus JE, Thomas RJ, Bianchi MT. Classification algorithms for predicting sleepiness and sleep apnea severity. J Sleep Res 2012; 21: 101-12.
12. 12. Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth 2010; 57: 423-38.
13. 13. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29-36.
14. 14. Hanley JA. Receiver operating characteristic (ROC) methodology: the state of the art. Crit Rev Diagn Imaging 1989; 29: 307-35.
15. 15. Zou KH, O’ Malley AJ, Mauri L. Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 2007; 115: 654-7.
16. 16. Janes H, Longton G, Pepe M. Accommodating Covariates in ROC Analysis. Stata J 2009; 9: 17-39.
17. 17. Erkorkmaz Ü, Çolak E, Bal C, Özdamar K, Etikan İ, Ekerbiçer HÇ. Covariate Adjusted ROC Curve Analysis and An Application. Sakarya Tıp Dergisi 2015; 5: 140-8.
18. 18. Demir E, Yavuz Y. Prostat Kanseri Tanısında PSA İçin İşlem Karakteristik Eğrisi Analizinde Ortak Değişken Düzeltmesi. Turkiye Klinikleri Journal of Biostatistics 2016; 8: 162-71.
19. 19. Janes H, Pepe MS. Adjusting for covariates in studies of diagnostic, screening, or prognostic markers: an old concept in a new setting. Am J Epidemiol. 2008;168: 89- 97.
20. 20. Pardo-Fernández JC, Rodriguez-Alvarez MX, Keilegom IV. A review on ROC curves in the presence of covariates. REVSTAT–Statistical Journal 2014;12: 21-41.
21. 21. Bonzelaar LB, Salapatas AM, Yang J, Friedman M. Validity of the epworth sleepiness scale as a screening tool for obstructive sleep apnea. Laryngoscope 2017; 127: 525-531.
22. 22. Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, Mokhlesi B, Chung F. Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis. PLoS One. 2015; 10: e0143697.
23. 23. Gander PH, Marshall NS, Harris R, Reid P. The Epworth Sleepiness Scale: influence of age, ethnicity, and socioeconomic deprivation. Epworth Sleepiness scores of adults in New Zealand. Sleep. 2005;28: 249-53.