Obstruktivna apneja v spanju v ambulanti družinske medicine

Pangerc, Andrej (author), Petek Šter, Marija (mentor), Dolenc Grošelj, Leja (comentor)

Namen: Namen doktorske naloge je bil prevesti in validirati vprašalnika STOP-BANG (SBQ) ter Epworthovo lestvico prekomerne dnevne zaspanosti (ESS), opredeliti smiselnost presejanja na obstruktivno apnejo v spanju (OSA) in razviti ter validirati dvostopenjski model presejanja na (OSA) v ambulanti družinske medicine. Metode: Prevoda SBQ in ESS smo naredili skladno s standardnim postopkom, sledil je vzvratni prevod in usklajevanje. Jezikovno validacijo smo izvedli na vzorcu zdravih oseb. Korelacijo med SBQ in ESS ter OSA smo izvedli na vzorcu oseb v laboratoriju za motnje spanja in v ambulanti družinske medicine. Oceno prevalence OSA smo izvedli na vzorcu zaporednih obiskovalcev v ambulanti družinske medicine, s pregledom baze Zunaj bolnišnične zdravstvene dejavnosti (ZUBSTAT) ter s poligrafijo tipa 3 pri naključno izbranih pacientih v ambulanti družinske medicine. Dvostopenjski model presejanja na OSA v ambulanti družinske medicine, ki temelji na vprašalniku SBQ in mu sledi avtomatizirana interpretacija poligrafije tipa 3, smo ocenili pri naključno izbranih pacientih v ambulantah družinske medicine. Rezultati: Uspešno smo prevedli in jezikovno validirali vprašalnika SBQ in ESS. SBQ je dobro koreliral z diagnozo OSA tako v laboratoriju za motnje spanja kot tudi v ambulanti družinske medicine, medtem ko pri ESS pomembne korelacije ni bilo. Dvostopenjski model presejanja na OSA je imel višjo občutljivost, specifičnost, negativno in pozitivno napovedno vrednost kot SBQ. Zaključek: S študijo smo v slovenščino prevedli vprašalnika SBQ in ESS. SBQ smo prepoznali kot zanesljivo klinično orodje za opredelitev stopnje tveganja za OSA. Razvili smo dvostopenjski model presejanja ter potrdili njegovo veljavnost za OSA ambulanti družinske medicine. Na podlagi pridobljenega znanja predlagamo implementacijo dvostopenjskega modela presejanja na OSA v ambulantah družinske medicine v sklopu rednih preventivnih zdravstvenih pregledov. Študija je odprla široko polje za sistemske spremembe obravnave OSA in nadaljnje raziskave.

• Language: Slovenian
• Keywords: Obstruktivna apneja v spanju, družinska medicina, primarni nivo zdravstvenega varstva, presejanje, vprašalnik STOP-BANG, Epworthova lestvica dnevne zaspanosti, polisomnografija, poligrafija.
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2023
• PID: 20.500.12556/RUL-152212
• Publication date in RUL: 11.11.2023

Secondary language

• Language: English
• Title: ​Obstructive sleep apnoea in a family practice setting

Abstract

Aim: The aim of this doctoral thesis was to translate and validate the STOP-BANG Questionnaire (SBQ) and the Epworth Sleepiness Scale (ESS), assess the feasibility of screening for obstructive sleep apnea (OSA), and develop and validate a two-stage screening model for OSA in family medicine clinics. Methods: Translation of the SBQ and ESS was conducted following a standardized procedure, including back-translation and harmonization. Language validation was performed on a sample of healthy individuals. Correlation between SBQ, ESS, and OSA was assessed in both a sleep disorders laboratory and in family medicine clinics. The assessment of OSA prevalence was conducted by reviewing the medical records of consecutive visitors to family medicine clinics, using data from the Outpatient Healthcare Activity Database (ZUBSTAT), as well as conducting type 3 polygraphy on randomly selected patients in family medicine clinics. The two-stage screening model for OSA in family medicine clinics, based on the SBQ questionnaire followed by automated interpretation of type 3 polygraphy, was evaluated in randomly selected patients. Results: Successful translation and linguistic validation of the SBQ and ESS were achieved. SBQ showed good correlation with the diagnosis of OSA in both the sleep disorders laboratory and the family medicine clinic, whereas ESS did not demonstrate significant correlations. The two-stage screening model for OSA exhibited higher sensitivity, specificity, negative predictive value, and positive predictive value compared to SBQ. Conclusions: In this study, we translated the SBQ and ESS questionnaires into Slovene. SBQ was identified as a reliable clinical tool for assessing the risk level of OSA. We developed and validated a two-stage screening model for OSA in family medicine clinics, confirming its validity. Based on the acquired knowledge, we propose implementing the two-stage screening model for OSA in family medicine clinics as part of routine preventive health check-ups. This study has opened a broad field for systemic changes in the management of OSA and further research.

• Keywords: Obstructive sleep apnea, family medicine, family practice, primary level of healthcare, screening, STOP-BANG questionnaire, Epworth Sleepiness Scale, polysomnography, polygraphy.