夜间动态血氧饱和度监测结合临床评分对阻塞性睡眠呼吸暂停低通气综合征患者的初筛价值

Nocturnal oximetry saturation monitoring combined with clinical score in preliminary screening of obstructive sleep apnea hypopnea syndrome

目的探讨夜间动态血氧饱和度监测结合临床评分(CS)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的筛查价值。方法纳入106例主诉为打鼾的患者,分别收集一般资料、病史,行整夜多导睡眠图(PSG)监测,同时佩戴舒气通血氧仪进行夜间动态血氧饱和度监测。根据睡眠呼吸暂停低通气指数(AHI)将患者分为非OSAHS和OSAHS组。对两组间PSG-AHI和血氧仪-氧减指数(ODI)进行相关分析,了解不同ODI值结合CS评分对OSAHS诊断的敏感性和特异性。结果非OSAHS组的AHI、ODI、CS值分别为(1.8±1.4)次/h、(2.6±3.5)次/h、(1.0±0.8)分,OSAHS组的AHI、ODI、CS值为(37.3±23.9)次/h、(31.0±24.1)次/h、(2.6±1.1)分,两组间比较,差异有统计学意义(P<0.01)。ODI与AHI存在良好相关性(r=0.943,P<0.01)。以ODI≥5次/h结合CS≥2分诊断OSAHS的敏感性为91.7%,特异性为94.1%,有初筛价值。以ODI≥10次/h结合CS≥2分作为标准时,诊断敏感性为77.8%,特异性为100.0%,不会误诊AHI>30次/h的重度患者,可作为初筛重度OSAHS的指标。结论对打鼾患者进行夜间动态血氧饱和度监测,同时结合CS评分,对OSAHS的临床筛查有重要价值。

Objective To discuss the screening and diagnostic value of nocturnal oximetry saturation monitoring combined with clinical score （CS） for patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods A total of 106 snorers were recruited in the analysis whose general information and medical history were collected respectively. All patients received polysomnography （PSG） and oximeter monitoring. The patients were divided into a non-OSAHS group and an OSAHS group according to apnea hypopnea index （AHI）. A correlation analysis was made between PSG-AHI and oximeter-ODI to analyze the diagnostic sensitivity and specificity of different ODI combined with CS for OSAHS. Results The AHI, ODI, CS for the non-OSAHS group were 1.8±1.4 times/h, 2.6±3.5 times/h and 1.0±0.8; while for the OSAHS group they were correspondingly 37.3±23.9 times/h, 31.0±24.1 times/h, 2.6±1.1. There was a significant correlation between ODI and AHI （r=0.943, P〈0.01）. The sensitivity and specificity of ODI≥5 times/h combined with CS≥2 for diagnosis of OSAHS were 91.7% and 94.1% respectively, which had the value of preliminary screening. The sensitivity and specificity of ODI≥10 times/h combined with CS≥2 for diagnosis of OSAHS were 77.8% and 100.0% respectively, which would not result in misdiagnose for severe patients with AHI 〉30 times/h, so it could be an index of severe OSAHS screening. Conclusion Nocturnal oxyhemoglobin saturation monitoring combined with clinical score is of significant value for initial diagnosis of OSAHS.