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：

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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.	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 成人阻塞性睡眠呼吸暂停基层诊疗指南(2018年). 中华全科医师杂志, 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, 赵丹, 张湘燕. 阻塞性睡眠呼吸暂停低通气综合征的流行病学及临床研究进展. 中国呼吸与危重监护杂志, 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, 艾丽, 等. 阻塞性睡眠呼吸暂停合并2型糖尿病的机制. 中国呼吸与危重监护杂志, 2024, 23(9): 666-672.
9.	郑天圣, 张慧娟. 阻塞性睡眠呼吸暂停综合征与代谢性疾病的研究进展. 心血管康复医学杂志, 2024, 33(3): 344-347.
10.	李文鹏, 李悦. 阻塞性睡眠呼吸暂停综合征与代谢综合征. 中国循环杂志, 2015, 30(05): 511-512.
11.	付卓志, 吴亚岑, 李媚希, 等. 阻塞性睡眠呼吸暂停严重度评估参数及诊断技术. 生物化学与生物物理进展, 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, 李艳兰, 等. 便携式睡眠监测仪筛查成人阻塞性睡眠呼吸暂停低通气综合征的可行性分析. 现代医学与健康研究电子杂志, 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.	韩新宇, 刘钢, 金龙, 等. 基于两样本孟德尔随机化法的BMI与阻塞性睡眠呼吸暂停综合征因果关系研究. 中国中西医结合耳鼻咽喉科杂志, 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, Akbaş 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.	吴仪伟, 张珂承, 孙运帷, 等. 阻塞性睡眠呼吸暂停低通气综合征与代谢性疾病的研究进展. 中国医药导报, 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.	温雯, 张凯楠, 陈玉岚, 等. 代谢指数作为预测因子与阻塞性睡眠呼吸暂停的相关性分析. 中国全科医学, 2023, 26(30): 3740-3747.
39.	施玮, 王增香, 郭浪, 等. 血清C反应蛋白与白蛋白比值对睡眠呼吸暂停综合征严重程度的预测价值. 临床与病理杂志, 2022, 42(5): 1055-1060.

1. 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 成人阻塞性睡眠呼吸暂停基层诊疗指南(2018年). 中华全科医师杂志, 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, 赵丹, 张湘燕. 阻塞性睡眠呼吸暂停低通气综合征的流行病学及临床研究进展. 中国呼吸与危重监护杂志, 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, 艾丽, 等. 阻塞性睡眠呼吸暂停合并2型糖尿病的机制. 中国呼吸与危重监护杂志, 2024, 23(9): 666-672.
9. 郑天圣, 张慧娟. 阻塞性睡眠呼吸暂停综合征与代谢性疾病的研究进展. 心血管康复医学杂志, 2024, 33(3): 344-347.
10. 李文鹏, 李悦. 阻塞性睡眠呼吸暂停综合征与代谢综合征. 中国循环杂志, 2015, 30(05): 511-512.
11. 付卓志, 吴亚岑, 李媚希, 等. 阻塞性睡眠呼吸暂停严重度评估参数及诊断技术. 生物化学与生物物理进展, 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, 李艳兰, 等. 便携式睡眠监测仪筛查成人阻塞性睡眠呼吸暂停低通气综合征的可行性分析. 现代医学与健康研究电子杂志, 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. 韩新宇, 刘钢, 金龙, 等. 基于两样本孟德尔随机化法的BMI与阻塞性睡眠呼吸暂停综合征因果关系研究. 中国中西医结合耳鼻咽喉科杂志, 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, Akbaş 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. 吴仪伟, 张珂承, 孙运帷, 等. 阻塞性睡眠呼吸暂停低通气综合征与代谢性疾病的研究进展. 中国医药导报, 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. 温雯, 张凯楠, 陈玉岚, 等. 代谢指数作为预测因子与阻塞性睡眠呼吸暂停的相关性分析. 中国全科医学, 2023, 26(30): 3740-3747.
39. 施玮, 王增香, 郭浪, 等. 血清C反应蛋白与白蛋白比值对睡眠呼吸暂停综合征严重程度的预测价值. 临床与病理杂志, 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

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