临床评分法：一种简易判断阻塞性睡眠呼吸暂停综合征病情的方法

Clinical score：a simple tool to evaluate the severity of obstructive sleep apnea syndrome

目的探索一种判断阻塞性睡眠呼吸暂停综合征（OSAHS）病情的临床评分法。方法对158例OSAHS患者的习惯性打鼾、睡眠时憋气、白天嗜睡、肥胖、高血压5项临床表现进行评分，探讨用临床评分法判断OSAHS病情的价值。结果两位医师的总评分结果分别为（7．94±3．22）、（7．62±3．08）分，两者呈高度正相关（r=0．97，P=0．00）；轻度、中度和重度OSAHS患者分别为43、47、68例，评分结果分别为（5．53±2．25）、（7．66±2．05）、（9．29±2．27）分，彼此之间差异均有统计学意义（P=0．00），总评分结果为（7．78±2．68）分，与呼吸暂停低通气指数（37．15±19．53）也呈显著正相关（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的敏感度为83．5％，特异度为74．4％，准确度为80．4％。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 score based on clinical symptoms and signs for evaluating the severity of obstructive sleep apnea syndrome （OSAHS）. Methods A total of 158 OSAHS patients were enrolled. Five clinical features,including habitual snore,sleep apnea,daytime sleepiness,obesity and hypertension were used to arrive at a clinical score and its value to evaluate severity of OSAHS was determined. Results The clinical score of the two assessors was （7.94 ± 3.22） and （7.62 ± 3.08） scores respectively and a highly significant positive correlation was obtained （r = 0.97, P = 0.00）. The clinical score of mild（43 cases）,moderate（47 cases） and severe OSAHS（68 cases） was （5.53 ± 2.25）, （7.66 ± 2.05） and （9.29 ± 2.27） scores respectively,and there was significant difference among three groups （P = 0.00）. The general clinical score of the two assessors was （7.78 ± 2.68 ） scores, the apnea-hypopnea index 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 values of clinical score for differentiating moderate-severe OSAHS from mild OSAHS was 7 scores, and the sensitivity, specificity and accuracy was 83.5%, 74.4% and 80.4% respectively. Conclusion Clinical score, with good reliability, validity and high accuracy,is a simple method to evaluate severity of OSAHS.