临床评分法在判断阻塞性睡眠呼吸暂停综合征病情中的应用

Clinical score: a simple tool to evaluate the severity of OSAHS.

目的探索一种判断阻塞性睡眠呼吸暂停综合征(OSAHS)病情的临床评分方法。方法对158例OS-AHS患者的习惯性打鼾、睡眠时憋气、白天嗜睡、肥胖、高血压等5项临床表现由两位医生分别独立进行评分,探讨用临床评分法判断OSAHS病情的价值。结果两位评分者的总评分结果分别为7.94±3.22和7.62±3.08,二者呈高度正相关(r=0.97,P=0.00);轻度、中度和重度OSAHS患者评分结果分别为5.53±2.25,7.66±2.05和9.29±2.27,彼此之间差异具有显著性意义(P=0.00),总评分结果(7.78±2.68)与呼吸暂停低通气指数(37.15±19.53)也呈显著正相关关系(r=0.70,P=0.00);ROC分析表明以临床评分最优截断点7分为界,区分轻度与中重度OSAHS的敏感性为敏感性为83.5%,特异性为74.4%,准确性为80.3%。结论临床评分法判断OSAHS患者病情具有较好的可靠性、有效性和较高的准确性。

Objective To develop a clinical symptoms and signs based scoring system for evaluating the severity of obstructive sleep apnea - hypopnea syndrome （OSAHS）. Methods A total of 158 OSAHS patients were enrolled. Clinical features of the patients including habitual snore, sleep apnea, daytime sleepiness, obesity and hypertension were used to obtain a clinical score. The value of the score for evaluating the severity of OSAHS was then determined. Results The clinical score evaluated by two assessors were 7.94 ± 3.22 and 7.62 ±3.08 respectively and a highly significant positive correlationt was observed （ r =0.97, P =0.00）. The clinical score of mild, moderate and severe OSAHS were 5.53 ± 2.25,7.66 ± 2.05 and 9.29 ± 2.27 respectively, and there were marked differences among the three groups （ P = 0.00）. The average clinical score of the two assessors was 7.78 ± 2.68, the apnea - hypopnea index （AHI） was 37.15 ± 19.53, and there was a significant positive correlation between them （ r = 0.70, P = 0.00）. By analysis of ROC curves, the cut - off value of clinical score for differentiate moderate - severe OSAHS from mild OSAHS was 7, and the sensitivity, specificity and accuracy were 83.5%, 74.4% and 80.3% respectively. Conclusion Clinical score is a simple, reliable and valid tool to evaluate the severity of OSAHS.