A prediction model for obstructive sleep apnea hypopnea syndrome in adults based on the ZJU index_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HUANG Jiali ¹ , HE Yang ¹ , HU Zhigang ² , WAN Xiaorong ² ,  DENG Hongyan ³

1. Clinical Nursing Research Center, Three Gorges University, Yichang, Hubei443002, P.R.China;
2. Department of Respiratory and Critical Care Medicine, The First School of Clinical Medicine of Three Gorges University & Yichang Central People's Hospital, Yichang, Hubei 443003, P.R.China;
3. Department of Discipline Inspection Committee Office, The First School of Clinical Medicine of Three Gorges University & Yichang Central People's Hospital, Yichang, Hubei 443003, P.R.China;

Corresponding?author：

DENG Hongyan, Email: 1160279690@qq.com

Keywords：

Obstructive sleep apnea apnea hypopnea syndrome; ZJU index; nomogram

DOI：

10.7507/1671-6205.202501055

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the association between the ZJU index and obstructive sleep apnea hypopnea syndrome (OSAHS) and to develop a prediction model based on ZJU index. Methods Clinical data of patients diagnosed by polysomnography were retrospectively collected from January 2021 to July 2024. Participants were categorized into OSAHS and non-OSAHS groups, and the general data of the two groups were compared. Regression analysis was performed to analyze the influencing factors of OSAHS, a prediction model of OSAHS was constructed based on the ZJU index, and the diagnostic efficacy was evaluated by using the subject's work characteristics (ROC) curve and calibration curve. Rusults A total of 211 patients were included in this study, including 165 in the OSAHS group and 46 in the non-OSAHS group. The multifactorial results showed that ZJU index and gender were the influencing factors for the occurrence of OSAHS (P<0.05), and a prediction model was constructed by combining the ZJU index with gender, and the area under the ROC curve (AUC) was 0.786 (95%CI: 0.717-0.85). The sensitivity was 51.5% and the specificity was 91.3%. The calibration curve showed good agreement between predicted and actual results. Conclusion ZJU index is associated with OSAHS, and the prediction model constructed by ZJU index combined with gender could be well used to predict the occurrence of OSAHS.

Citation： HUANG Jiali, HE Yang, HU Zhigang, WAN Xiaorong, DENG Hongyan. A prediction model for obstructive sleep apnea hypopnea syndrome in adults based on the ZJU index. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(6): 395-401. doi: 10.7507/1671-6205.202501055 Copy

1.	中華醫學會, 中華醫學會雜志社, 中華醫學會全科醫學分會, 等. 成人阻塞性睡眠呼吸暫停基層診療指南(2018年). 中華全科醫師雜志, 2019, 18(1): 21-29.
2.	Benjafield A V, Ayas N T, Eastwood P R, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med, 2019, 7(8): 687-698.
3.	程建琴, 趙丹, 張湘燕. 阻塞性睡眠呼吸暫停低通氣綜合征的流行病學及臨床研究進展. 中國呼吸與危重監護雜志, 2023, 22(12): 899-903.
4.	Mao Z, Zheng P, Zhu X, et al. Obstructive sleep apnea hypopnea syndrome and vascular lesions: An update on what we currently know. Sleep Med, 2024, 119: 296-311.
5.	Ryan S, Taylor C T, McNicholas W T. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Thorax, 2009, 64(7): 631-636.
6.	Barateau L, Baillieul S, Andrejak C, et al. Guidelines for the assessment and management of residual sleepiness in obstructive apnea-hypopnea syndrome: Endorsed by the French Sleep Research and Medicine Society (SFRMS) and the French Speaking Society of Respiratory Diseases (SPLF). Respir Med Res, 2024, 86: 101105.
7.	Kawasaki Y, Kitamura E, Kasai T. Impact of Body Composition on Sleep and Its Relationship with Sleep Disorders: Current Insights. Nat Sci Sleep, 2023, 15: 375-388.
8.	洪雪玲, 李永霞, 艾麗, 等. 阻塞性睡眠呼吸暫停合并2型糖尿病的機制. 中國呼吸與危重監護雜志, 2024, 23(9): 666-672.
9.	鄭天圣, 張慧娟. 阻塞性睡眠呼吸暫停綜合征與代謝性疾病的研究進展. 心血管康復醫學雜志, 2024, 33(3): 344-347.
10.	李文鵬, 李悅. 阻塞性睡眠呼吸暫停綜合征與代謝綜合征. 中國循環雜志, 2015, 30(05): 511-512.
11.	付卓志, 吳亞岑, 李媚希, 等. 阻塞性睡眠呼吸暫停嚴重度評估參數及診斷技術. 生物化學與生物物理進展, 2024: 1-16.
12.	Domingues DM, Rocha PR, Miachon A, et al. Sleep prediction using data from oximeter, accelerometer and snoring for portable monitor obstructive sleep apnea diagnosis. Sci Rep, 2024, 14(1): 24562.
13.	Zhao R, Xue J, Dong XS, et al. Screening for obstructive sleep apnea using a contact-free system compared with polysomnography. J Clin Sleep Med, 2021, 17(5): 1075-1082.
14.	Tang H, Lv F, Zhang P, et al. The impact of obstructive sleep apnea on nonalcoholic fatty liver disease. Front Endocrinol (Lausanne), 2023, 14: 1254459.
15.	Wang J, Xu C, Xun Y, et al. ZJU index: a novel model for predicting nonalcoholic fatty liver disease in a Chinese population. Sci Rep, 2015, 5: 16494.
16.	Wang L, Nie G, Yan F, et al. The ZJU index is associated with the risk of obstructive sleep apnea syndrome in Chinese middle-aged and older people: a cross-sectional study. Lipids Health Dis, 2023, 22(1): 207.
17.	Phillips C L, Chapman J L, Yee B J. Weighing the evidence for excess weight and weight loss in the management of obstructive sleep apnea.'Fat' or fiction? Sleep Med Rev, 2024, 78: 102020.
18.	Read N, Jennings C, Hare A. Obstructive sleep apnoea-hypopnoea syndrome. Emerg Top Life Sci, 2023, 7(5): 467-476.
19.	曾莉, 涂燕玲, 李艷蘭, 等. 便攜式睡眠監測儀篩查成人阻塞性睡眠呼吸暫停低通氣綜合征的可行性分析. 現代醫學與健康研究電子雜志, 2022, 6(12): 95-98.
20.	Popadic V, Brajkovic M, Klasnja S, et al. Correlation of Dyslipidemia and Inflammation With Obstructive Sleep Apnea Severity. Front Pharmacol, 2022, 13: 897279.
21.	韓新宇, 劉鋼, 金龍, 等. 基于兩樣本孟德爾隨機化法的BMI與阻塞性睡眠呼吸暫停綜合征因果關系研究. 中國中西醫結合耳鼻咽喉科雜志, 2024, 32(01): 38-41.
22.	Hang L W, Liang S J, Finnsson E, et al. Endotypic Traits Characterizing Obesity and Sleep-related Hypoventilation in Patients with Obstructive Sleep Apnea. Ann Am Thorac Soc, 2024.
23.	Liu W, Song S, Zhang H, et al. A comparative analysis of anthropometric indices for diagnosing obstructive sleep apnea among American Adults. Sci Rep, 2024, 14(1): 29578.
24.	Peppard P E, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA, 2000, 284(23): 3015-3021.
25.	Alenezi M A, Alabdulathim S, Alhejaili S, et al. The Association Between Obesity and the Development and Severity of Obstructive Sleep Apnea: A Systematic Review. Cureus, 2024, 16(9): e69962.
26.	Chen L, Chen B, Dai Y, et al. The association of objective daytime sleepiness with impaired glucose metabolism in patients with obstructive sleep apnea: a multi-omics study. Sleep, 2024.
27.	Fernandes JL, Martins FO, Olea E, et al. Chronic Intermittent Hypoxia-Induced Dysmetabolism Is Associated with Hepatic Oxidative Stress, Mitochondrial Dysfunction and Inflammation. Antioxidants (Basel), 2023, 12(11).
28.	Karadeniz Y, Onat A, Akba? T, et al. Determinants of obstructive sleep apnea syndrome: Pro-inflammatory state and dysfunction of high-density lipoprotein. Nutrition, 2017, 43-44: 54-60.
29.	Zhu C, Tang S, Xiao J, et al. Insulin Resistance, but Not Obstructive Sleep Apnea Is Associated with Hepatic Steatosis in Chinese Patients with Severe Obesity. Obes Facts, 2023, 16(4): 344-355.
30.	Pan X, Liu F, Fan J, et al. Association of Body Roundness Index and A Body Shape Index with Obstructive Sleep Apnea: insights from NHANES 2015-2018 data. Front Nutr, 2024, 11: 1492673.
31.	Li L, You W, Ren W. The ZJU index is a powerful index for identifying NAFLD in the general Chinese population. Acta Diabetol, 2017, 54(10): 905-911.
32.	Li X, Qin P, Cao L, et al. Dose-response association of the ZJU index and fatty liver disease risk: A large cohort in China. J Gastroenterol Hepatol, 2021, 36(5): 1326-1333.
33.	吳儀偉, 張珂承, 孫運帷, 等. 阻塞性睡眠呼吸暫停低通氣綜合征與代謝性疾病的研究進展. 中國醫藥導報, 2023, 20(08): 50-53.
34.	Grote L, Jonzon YA, Barta P, et al. The Swedish sleep apnea registry (SESAR) cohort - "Real world data" on a national level. Sleep Med, 2024, 124: 362-370.
35.	Bertelli F, Suehs CM, Mallet JP, et al. Apnoea-hypopnoea indices determined via continuous positive airway pressure (AHI-CPAP(flow)) versus those determined by polysomnography (AHI-PSG(gold)): a protocol for a systematic review and meta-analysis. BMJ Open, 2021, 11(5): e44499.
36.	Godoy PH, Nucera A, Colcher AP, et al. Screening for obstructive sleep apnea in elderly: performance of the Berlin and STOP-Bang questionnaires and the Epworth sleepiness scale using polysomnography as gold standard. Sleep Sci, 2022, 15(2): 136-142.
37.	Kang HH, Kim SW, Lee SH. Association between triglyceride glucose index and obstructive sleep apnea risk in Korean adults: a cross-sectional cohort study. Lipids Health Dis, 2020, 19(1): 182.
38.	溫雯, 張凱楠, 陳玉嵐, 等. 代謝指數作為預測因子與阻塞性睡眠呼吸暫停的相關性分析. 中國全科醫學, 2023, 26(30): 3740-3747.
39.	施瑋, 王增香, 郭浪, 等. 血清C反應蛋白與白蛋白比值對睡眠呼吸暫停綜合征嚴重程度的預測價值. 臨床與病理雜志, 2022, 42(5): 1055-1060.

1. 中華醫學會, 中華醫學會雜志社, 中華醫學會全科醫學分會, 等. 成人阻塞性睡眠呼吸暫停基層診療指南(2018年). 中華全科醫師雜志, 2019, 18(1): 21-29.
2. Benjafield A V, Ayas N T, Eastwood P R, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med, 2019, 7(8): 687-698.
3. 程建琴, 趙丹, 張湘燕. 阻塞性睡眠呼吸暫停低通氣綜合征的流行病學及臨床研究進展. 中國呼吸與危重監護雜志, 2023, 22(12): 899-903.
4. Mao Z, Zheng P, Zhu X, et al. Obstructive sleep apnea hypopnea syndrome and vascular lesions: An update on what we currently know. Sleep Med, 2024, 119: 296-311.
5. Ryan S, Taylor C T, McNicholas W T. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Thorax, 2009, 64(7): 631-636.
6. Barateau L, Baillieul S, Andrejak C, et al. Guidelines for the assessment and management of residual sleepiness in obstructive apnea-hypopnea syndrome: Endorsed by the French Sleep Research and Medicine Society (SFRMS) and the French Speaking Society of Respiratory Diseases (SPLF). Respir Med Res, 2024, 86: 101105.
7. Kawasaki Y, Kitamura E, Kasai T. Impact of Body Composition on Sleep and Its Relationship with Sleep Disorders: Current Insights. Nat Sci Sleep, 2023, 15: 375-388.
8. 洪雪玲, 李永霞, 艾麗, 等. 阻塞性睡眠呼吸暫停合并2型糖尿病的機制. 中國呼吸與危重監護雜志, 2024, 23(9): 666-672.
9. 鄭天圣, 張慧娟. 阻塞性睡眠呼吸暫停綜合征與代謝性疾病的研究進展. 心血管康復醫學雜志, 2024, 33(3): 344-347.
10. 李文鵬, 李悅. 阻塞性睡眠呼吸暫停綜合征與代謝綜合征. 中國循環雜志, 2015, 30(05): 511-512.
11. 付卓志, 吳亞岑, 李媚希, 等. 阻塞性睡眠呼吸暫停嚴重度評估參數及診斷技術. 生物化學與生物物理進展, 2024: 1-16.
12. Domingues DM, Rocha PR, Miachon A, et al. Sleep prediction using data from oximeter, accelerometer and snoring for portable monitor obstructive sleep apnea diagnosis. Sci Rep, 2024, 14(1): 24562.
13. Zhao R, Xue J, Dong XS, et al. Screening for obstructive sleep apnea using a contact-free system compared with polysomnography. J Clin Sleep Med, 2021, 17(5): 1075-1082.
14. Tang H, Lv F, Zhang P, et al. The impact of obstructive sleep apnea on nonalcoholic fatty liver disease. Front Endocrinol (Lausanne), 2023, 14: 1254459.
15. Wang J, Xu C, Xun Y, et al. ZJU index: a novel model for predicting nonalcoholic fatty liver disease in a Chinese population. Sci Rep, 2015, 5: 16494.
16. Wang L, Nie G, Yan F, et al. The ZJU index is associated with the risk of obstructive sleep apnea syndrome in Chinese middle-aged and older people: a cross-sectional study. Lipids Health Dis, 2023, 22(1): 207.
17. Phillips C L, Chapman J L, Yee B J. Weighing the evidence for excess weight and weight loss in the management of obstructive sleep apnea.'Fat' or fiction? Sleep Med Rev, 2024, 78: 102020.
18. Read N, Jennings C, Hare A. Obstructive sleep apnoea-hypopnoea syndrome. Emerg Top Life Sci, 2023, 7(5): 467-476.
19. 曾莉, 涂燕玲, 李艷蘭, 等. 便攜式睡眠監測儀篩查成人阻塞性睡眠呼吸暫停低通氣綜合征的可行性分析. 現代醫學與健康研究電子雜志, 2022, 6(12): 95-98.
20. Popadic V, Brajkovic M, Klasnja S, et al. Correlation of Dyslipidemia and Inflammation With Obstructive Sleep Apnea Severity. Front Pharmacol, 2022, 13: 897279.
21. 韓新宇, 劉鋼, 金龍, 等. 基于兩樣本孟德爾隨機化法的BMI與阻塞性睡眠呼吸暫停綜合征因果關系研究. 中國中西醫結合耳鼻咽喉科雜志, 2024, 32(01): 38-41.
22. Hang L W, Liang S J, Finnsson E, et al. Endotypic Traits Characterizing Obesity and Sleep-related Hypoventilation in Patients with Obstructive Sleep Apnea. Ann Am Thorac Soc, 2024.
23. Liu W, Song S, Zhang H, et al. A comparative analysis of anthropometric indices for diagnosing obstructive sleep apnea among American Adults. Sci Rep, 2024, 14(1): 29578.
24. Peppard P E, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA, 2000, 284(23): 3015-3021.
25. Alenezi M A, Alabdulathim S, Alhejaili S, et al. The Association Between Obesity and the Development and Severity of Obstructive Sleep Apnea: A Systematic Review. Cureus, 2024, 16(9): e69962.
26. Chen L, Chen B, Dai Y, et al. The association of objective daytime sleepiness with impaired glucose metabolism in patients with obstructive sleep apnea: a multi-omics study. Sleep, 2024.
27. Fernandes JL, Martins FO, Olea E, et al. Chronic Intermittent Hypoxia-Induced Dysmetabolism Is Associated with Hepatic Oxidative Stress, Mitochondrial Dysfunction and Inflammation. Antioxidants (Basel), 2023, 12(11).
28. Karadeniz Y, Onat A, Akba? T, et al. Determinants of obstructive sleep apnea syndrome: Pro-inflammatory state and dysfunction of high-density lipoprotein. Nutrition, 2017, 43-44: 54-60.
29. Zhu C, Tang S, Xiao J, et al. Insulin Resistance, but Not Obstructive Sleep Apnea Is Associated with Hepatic Steatosis in Chinese Patients with Severe Obesity. Obes Facts, 2023, 16(4): 344-355.
30. Pan X, Liu F, Fan J, et al. Association of Body Roundness Index and A Body Shape Index with Obstructive Sleep Apnea: insights from NHANES 2015-2018 data. Front Nutr, 2024, 11: 1492673.
31. Li L, You W, Ren W. The ZJU index is a powerful index for identifying NAFLD in the general Chinese population. Acta Diabetol, 2017, 54(10): 905-911.
32. Li X, Qin P, Cao L, et al. Dose-response association of the ZJU index and fatty liver disease risk: A large cohort in China. J Gastroenterol Hepatol, 2021, 36(5): 1326-1333.
33. 吳儀偉, 張珂承, 孫運帷, 等. 阻塞性睡眠呼吸暫停低通氣綜合征與代謝性疾病的研究進展. 中國醫藥導報, 2023, 20(08): 50-53.
34. Grote L, Jonzon YA, Barta P, et al. The Swedish sleep apnea registry (SESAR) cohort - "Real world data" on a national level. Sleep Med, 2024, 124: 362-370.
35. Bertelli F, Suehs CM, Mallet JP, et al. Apnoea-hypopnoea indices determined via continuous positive airway pressure (AHI-CPAP(flow)) versus those determined by polysomnography (AHI-PSG(gold)): a protocol for a systematic review and meta-analysis. BMJ Open, 2021, 11(5): e44499.
36. Godoy PH, Nucera A, Colcher AP, et al. Screening for obstructive sleep apnea in elderly: performance of the Berlin and STOP-Bang questionnaires and the Epworth sleepiness scale using polysomnography as gold standard. Sleep Sci, 2022, 15(2): 136-142.
37. Kang HH, Kim SW, Lee SH. Association between triglyceride glucose index and obstructive sleep apnea risk in Korean adults: a cross-sectional cohort study. Lipids Health Dis, 2020, 19(1): 182.
38. 溫雯, 張凱楠, 陳玉嵐, 等. 代謝指數作為預測因子與阻塞性睡眠呼吸暫停的相關性分析. 中國全科醫學, 2023, 26(30): 3740-3747.
39. 施瑋, 王增香, 郭浪, 等. 血清C反應蛋白與白蛋白比值對睡眠呼吸暫停綜合征嚴重程度的預測價值. 臨床與病理雜志, 2022, 42(5): 1055-1060.

Chinese Journal of Respiratory and Critical Care Medicine

A prediction model for obstructive sleep apnea hypopnea syndrome in adults based on the ZJU index

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content