Development And Testing Research On Obstructive Sleep Apnea Syndrome Scale For Elder Adults

BACKGROUNDObstructive sleep apnea syndrome is a serious chronic disease with the symptoms of low SpO₂, hypercapnia, sleep structure confused, quit breathing, choke, headache, dizzy, sleepiness in day time, debilitation. And the worst is sudden death. The morbidity rate of this disease in the elder adult is 20%⁴0%. But few of them ask doctor for help initiatively. Overnight polysomnography (PSG) is considered to be the gold standard for diagnosis of OSAS, however, prohibitive cost of the test and long waiting lists limit its widespread access. Although symptom questionnaires have been developed to predict presence of OSAS, their overall reliability and utility have not been established. The Berlin questionnaire is an instrument validated to use in the western population to determine the occurrence of risk factors for OSAS namely snoring behavior, wake-time sleepiness or fatigue and the presence of obesity or hypertension. In 2006, professor S.K.sharma in Indian modified the Berlin questionnaire into an Indian setting and named it Modified Berlin questionnaire. It's more suitable for the eastern people.Comparing with the research in foreign countries, the OSAS measure tools are insufficient in China. We can only see some researchers use the Epworth Sleepiness Scale to predict the risk of OSAS, but it reliability and utility is not at the good level. So it is necessary for medical professionals to do further research in this field.OBJECTIVESTo explore effective OSAS assessment tools for the elderly in china. (1) Translate the modified Berlin questionnaire into Chinese and investigate the scale's reliability and validity. (2) To explore a screening scale for the elder adult of china to predict the likelihood of OSAS.METHODS(1) After getting the permission from professor S.K.Sharma, translated the MBQ into Chinese. A discussion and a two-round test were used to test the equivalency between the MBQ and the Chinese version.(2) 136 people who were older than 60 were engaged in the investigation and 124 of them were utility. All quantitative data of questionnaire survey was analyzed by SPSS 11.5. Do the reliability and validity analysis to evaluate the value of MBQ. Test-retest reliability coefficient, Cronbach's alpha coefficient were used to evaluate the reliability. Correlation analysis and factor analysis were used to test the validity.(3) Based on the research of BMQ and theory of self-directed learning, a new screening scale was established. The new scale has 25 items, which were classified into 4 dimensions. 148 older adults were employed to answer the questionnaire. All quantitative data of questionnaire survey was analyzed by SPSS11.5. Do the reliability and validity analysis to evaluate the value of MBQ. Test-retest reliability coefficient, Cronbach's alpha coefficient were used to evaluate the reliability. Correlation analysis and factor analysis were used to test the validity.RESULTS(1) The answers of two rounds test with BMQ and BMQ Chinese version were completely the same except S3, B2, B4, and Cl. Spearman coefficient correlation was use to these 4 items. Spearman coefficient correlation were ranging 0.688⁰.999. The results were significant ( r> 0.688, p<0.002). Spearman coefficient correlation was use to scores of column 1, column 2 and the whole questionnaire. Spearman coefficient correlation were ranging 0.725-1.000. The results were significant (r>0.725, p<0.001) .(2) The validity recovery rate of MBQ Chinese version is 91.18%. Cross tabulation with chi-square tests were used to analyze which variables are associated with OSAS. The difference between different gender is significant ( x² =4.544, P=0.033 ). The test-retest reliability were0.776- 0.992. The Cronbach'salpha coefficient for the scale was 0.6698. Exploratory principal component analysis of the scale's items identified a four first-order factors model that accounted for 61.520% of the total variance. The result indicated that the structure of the scale was similar to the theory construction. The correlation analysis between each item and its corresponding dimension indicated that the scale had very high discrimination validity and structure validity because each item was highly correlated with the dimension it belonged to and that the correlation between each dimension and the total score was greater than the correlation between different dimensions. The gold standard diagnoses trial with PSG showed the sensitivity of scale was 82%, and the specificity was 54.16%. The critical value of body mass index and neck circle/neck length were 25 and 5.27.(3) The validity recovery rate of Obstructive sleep apnea syndrome risk assessment scale for the older (OSASRAS) is 91.89%. The test-retest reliability were 0.798-0.997. The Cronbach's alpha coefficient for the scale was 0.9036. Exploratory principal component analysis of the scale's items identified a four first-order factors model that accounted for 66.412% of the total variance. The correlation analysis between each item and its corresponding dimension indicated that the scale had very high discrimination validity and structure validity because each item was highly correlated with the dimension it belonged to except item 9 and that the correlation between each dimension and the total score was greater than the correlation between different dimensions. Two-independent sample test was used to test the difference of the score of the scale and each subscale between the OSAS positive elder and the OSAS negative elder. The results were significant (P<0.009) . The area under curve of total score was 0.933, 95% confidence interval was 0.895-0.976. When the critical value was 57, the sensitivity of scale was 84.1%, and the specificity was 81.2%.CONCLUSIONS(1) Because of the difference in culture, nation, body constitution, using the MBQ Chinese version to predict the OSAS risk of Chinese elder adults was not so satisfied. We can do more work based this research to explore a new scale.(2)OSASRAS is initially established. The developed scale in this study showed excellent reliability and validity and was an appropriate measure instrument that can be used to assessing the risk of OSAS for Chinese elder adults. However, the findings of the present study need to be confirmed further in a large number of subjects in a community-based setting.