阻塞性睡眠呼吸暂停低通气综合征患者嗜睡程度与驾驶车辆能力的关系研究

Daytime sleepiness and driving ability in obstructive sleep apnea-hypopnea syndrome drivers

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者日间嗜睡与夜间缺氧程度及疾病严重程度的关系。方法对2007年7月至2008年1月中国医科大学附属第一医院呼吸内科经多导睡眠呼吸监测确诊的32例男性OSAHS患者与10例单纯鼾症男性对照者进行嗜睡评分以及全夜多导睡眠监测,根据不同睡眠呼吸暂停低通气指数(AHI)分组,比较其嗜睡情况与驾驶车辆能力,并与AHI和夜间低氧程度进行相关分析。结果(1)OSAHS组驾驶车辆能力下降、嗜睡评分明显高于对照组[(15.34±4.80)分对(7.60±4.65)分,P<0.05],并且随着AHI的增加(r=0.782,P<0.001)、最低血氧饱和度的降低(r=-0.744,P<0.001),其嗜睡评分增加。(2)多元逐步回归表明,AHI、最低血氧与患者日间嗜睡程度密切相关,其回归方程为Y(日间嗜睡评分)=19.441-0.132X1(最低血氧饱和度)+0.109X2(AHI)(R2=0.651,P<0.05)。结论(1)OSAHS患者有较大的驾车安全隐患,并且重度的OSAHS患者尤为明显。(2)OSAHS患者日间嗜睡程度与AHI和最低血氧均密切相关。

Objective To evaluate the relationship between excessive daytime sleepiness and nocturnal hypoxemia and apnea-hypopnea index（AHI）. Methods Polysomnography was carried out in thirty-two patients with obstructive sleep apnea-hypopnea syndrome（OSAHS） and ten controls. The Epworth Sleepiness Scale（ESS） and driving ability were also evaluated in these subjects. In order to assess the relationship between sleepiness and nocturnal hypoxemia and severity of OSAHS, the patients were divided into three groups according to AHI, and multiple stepwise regression was used. Results （1） Patients with OSAHS had low driving ability and higher ESS Scale than controls （ESS Scale 15.34 ± 4. 80 and 7. 60 ± 4. 65 respectively, P 〈 0.05 ）. ESS was correlated with AHI （ r = 0. 782, P 〈 0. 001 ） and nadir nocturnal oxygen saturation（ MmSpO2 ）（ r = -0. 744 ,P 〈 0. 001 ）. （2）Multiple stepwise regression showed that ：ESS was correlated with AHI and nadir nocturnal oxygen saturation（ MmSpO2 ）. The equation was as follows ：Y（ESS） = 19. 441 - 0. 132X1 （ MmSpO2 ） ＋ 0. 109X2 （AHI） （ R^2 = 0. 651,P 〈 0.05 ）. Conclusion （ 1 ） Patients with OSAHS have more severe daytime sleepiness and significantly decreased driving ability, which means high risk to car accidents, especially in patients with AHI ≥40. （2） ESS is closely correlated with AHI and nadir nocturnal oxygen saturation（ MmSpO2 ）in OSAHS patients.