Epworth嗜睡评分与夜间睡眠多导图监测对诊断高原阻塞性睡眠呼吸暂停低通气综合征的相关性研究

Correlation between the epworth sleepiness scale and polysomnographys in diagnosis of obstructive sleep apnea-hyponea syndrome at high altitude

目的探讨Epworth嗜睡评分(ESS)与夜间睡眠多导图(PSG)对诊断高原阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的相关性。方法选择高原慢性阻塞性肺疾病急性加重期(AECOPD)患者226例,经PSG监测,确诊为COPD合并OSAHS(重叠综合征,OS)患者116例(A组),单纯COPD患者110例(B组)。对两组患者分别进行监测夜间睡眠呼吸暂停低通气指数(AHI)、平均氧饱和度(MSaO_2)、平均最低氧饱和度(MmSaO_2)和记录白天ESS,并测定体质指数(BMI)和颈围(Nc)。结果 A组BMI、Nc、ESS、AHI[分别为(27.82±4.36)kg/m^2、(48.98±6.19)cm、(14.56±4.10)分、(51.03±10.24)次/h)]显著高于B组[分别为(22.56±3.98)kg/m^2、(40.76±6.03)cm、(2.67±0.85)分、(3.12±1.20)次/h,MSaO_2和MmSaO_2[分别为(66.38±7.52)%、(52.87±8.06)%]显著低于B组分别为(76.35±7.86)%、(67.65±7.86)%](均P<0.01)。在A组中,COPDⅣ级组BMI、Nc、ESS、AHI[分别为(29.33±4.46)kg/m2、(52.42±6.31)cm、(16.77±4.29)分、(57.02±10.60)次/h]显著高于Ⅱ组[分别为(26.15±4.16)kg/m2、(46.05±5.89)cm、(12.06±3.88)分、(46.85±9.68)次/h,MSaO_2和MmSaO_2[分别为(62.55±7.47)%、(48.12±8.00)%]显著低于Ⅱ级组(70.77±7.86)%、(57.92±8.26)%](均P<0.01);ESS、AHI、MSaO_2和MmSaO_2在Ⅲ级组[分别为(14.37±4.09)分、(52.09±10.34)次/h、(66.64±7.29)%、(53.44±7.96)%],与Ⅱ级组之间差异有显著性(均P<0.05)。A组ESS与AHI、BMI、Nc呈显著正相关(r=0.856、0.776、0.782,P<0.001),与MSaO_2、MmSaO_2呈显著负相关(r=-0.815,-0.798,P<0.001)。结论 ESS与AHI、BMI、Nc、MSaO_2和MmSaO_2具有良好的相关性,可用于OSAHS患者的筛查和病情严重程度的评估。

Objective To assess the correlation between the epworth sleepiness scale（ ESS） and olysomnographys（ PSG） in diagnosis of obstructive sleep apnea-hyponea syndrome（ OSAHS） at high altitude.Methods A total of 226 cases in acute exacerbatoin of chronic obstructive pulmonary disease（ AECOPD） were enrolled in this study,According to the PSG monitoring,they were divided into two groups： 116 patients with COPD and OSAHS（ overlap syndrome,OS）,110 patients with pure COPD. apnea hypopnea index（ AHI）,mean oxygen saturation（ MSaO_2）,mean minimum oxygen saturation（ MmSaO_2） period of sleep at night,body mass index（ BMI）,neck circumference（ Nc） and ESS during the day were examined. Results BMI,Nc,ESS,AHI[（ 27. 82 ± 4. 36） kg / m^2,（ 48. 98 ± 6. 19） cm,（ 14. 56 ± 4. 10） score,（ 51. 03 ± 10. 24） time/h）,respectively] were significantly higher,MSaO_2 and MmSaO_2[（ 66.38±7.52） % and（ 52.87±8.06） %] were significantly lower in os group than those in pure COPD group[（ 22.56±3.98） kg / m^2,（ 40.76±6.03） cm,（ 2.67±0.85） score,（ 3.12±1. 20） time / h,（ 76. 35 ± 7. 86） %,（ 67. 65 ± 7. 86） %,respectively]（ all P〈0. 01）. In os group,BMI,ESS,Nc and AHI[（ 29.33±4.46） kg / m^2,（ 52.42±6.31） cm,（ 16.77±4.29） score,（ 57.02±10.60）time / h,respectively] were significantly higher,MSaO 2and MmSaO_2[（ 62.55±7.47） %,（ 48.12±8.00） %,respectively] were significantly lower in group COPD Ⅳ than those in group COPD Ⅱ [（ 26.15±4.16） kg / m^2,（ 46.05±5. 89） cm,（ 12. 06 ± 3. 88） score,（ 46. 85 ± 9. 68） time/h,（ 70. 77 ± 7. 86） %,（ 57. 92 ± 8. 26） %,respectively]（ all P0.01）. ESS,AHI,MSaO 2and MmSaO_2were significantly difference between group COPDⅣ and Ⅲ [（ 14. 37 ± 4. 09） score,（ 52. 09 ± 10. 34） time /h,（ 66. 64 ± 7. 29） % and（ 53. 44 ± 7. 96） %,respectively],and between group Ⅲ and Ⅱ（ all P〈0. 05）. In os group,ESS was positively correlated with AHI,BMI and Nc（ r = 0.856,0.776,0.782,P〈0.001）,was negatively correlated with MSaO 2and MmSaO_2（ r=-0.815,-0.798,P0.001）. Conclusion ESS has a good correlation with AHI,BMI,Nc,MSaO_2 and MmSaO_2,ESS can be used as screening and to evaluate the degree of OSAHS at high altitude.