阻塞性睡眠呼吸暂停低通气综合征患者日间嗜睡主客观评价方法的对比

Comparing multcple sleep latency test and epworth sleepiness scale in the measurement of excessive daytime sleepiness in patients with obstructive sleep apnea-hyponea syndrome

目的对Epworth嗜睡量表(ESS)和多次小睡潜伏时间(MSLT)在OSAHS患者白天嗜睡中的地位进行初步探讨。方法纳入2011年1月至2012年10月本科因鼾症就诊的患者120例,根据多导睡眠监测结果进行分组:单纯性鼾症组30例,其中男24例,女6例;OSAHS组90例,其中男78例,女12例。采用ESS简体中文版进行嗜睡程度主观评估,MSLT试验进行嗜睡程度客观评估。结果各试验组患者在男女比例、年龄、体重指数等方面无差别。随着OSAHS病情的加重,ESS评分呈上升趋势,多次小睡潜伏时间呈下降趋势。相关性分析表明ESS评分、多次小睡潜伏时间均与OSAHS病情相关。可信性分析表明ESS简体中文版总Cronbachα系数为0.70,其中部分条目与总体的相关性差。结论 ESS简体中文版及MSLT均可用于OSAHS患者日间嗜睡的评价。为方便计算,在临床上可优先采用ESS,但需要适当改良以适应中国人的实际情况。对于对嗜睡程度评价要求较高的情况,则应采用MSLT。

Objective To compare the use of multiple sleep latency test （MSLT） and epworth sleepiness scale （ESS） in measuring excessive daytime sleepiness （EDS） in patients with different severity of obstructive sleep apnea-hyponea syndrome （OSAHS）. Methods 120 adult habitual snorers treated by respiratory physicians in First Hospital of Quanzhou Affiliated to Fujian Medical University were selected for this study. The patients were grouped as simple snorers and OSAHS by the Results of polysomnography test： 30 patients were in the simple snorer group, with 24 male and 6 female. 90 patients were in the OSAHS group, with 78 male and 12 female. EDS were measured by a Chinese version of ESS and a five-nap MSLT. Results There was no significant difference in gender, age, and body mass index between the two groups. As the condition of OSAHS worsened, the ESS scores increased and mean sleep latencies decreased. Pearson correlation analysis showed that ESS scores were positively correlated with severity of OSAHS （determined by AHI） and mean sleep latencies were negatively correlated with severity of OSAHS. The Chinese version of ESS had a moderate level of internal consistency and 3 items had poor relation with total as measured by Cronbach＇s alpha （α=0.70, 0.1~0.3 respectively）. Conclusion Both MSLT and Chinese version of ESS are useful in the measurement of EDS in Chinese population. ESS, although some modification is needed, is a relatively simple and cost-effective method for clinical practice. But for research, MSLT is better than ESS in the measurement of EDS in relation to the severity of OSAHS.