Epworth嗜睡量表联合家庭便携式睡眠监测诊断成人阻塞性睡眠呼吸暂停综合征

Value of Epworth sleepiness scale combined with homebased portable monitoring in the diagnosis of obstructive sleep apnea syndrome in adult patients

目的评价Epworth嗜睡量表(ESS)筛查出可疑阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者,再应用家庭便携式睡眠监测(por table monitoring,PM)诊断OSAS的价值。方法以睡眠打鼾为主要症状就诊于北京同仁医院的成年患者,于睡眠监测中心接受整夜多道睡眠图(PSG)监测,同时填写ESS,1周内完成PM。以PSG监测呼吸暂停低通气指数(AHI)为依据,将研究对象分为单纯打鼾轻度OSAS组(AHI<15次/h)和中重度OSAS组(AHI≥15次/h);比较两组间ESS评分、PM呼吸紊乱指数(respiratory disturbance index,RDI),分析ESS评分、RDI与A HI的相关性;计算ESS评分≥9分、RDI≥15次/h诊断中重度OSAS的敏感度和特异度。结果共纳入51例研究对象,其中男42例(82.4%),女9例(17.6%);平均年龄(43.8±10.8)岁;平均体质量指数(27.9±4.5)kg/m^2;ESS评分1~24分,平均(8.6±5.0)分,其中ESS评分≥9分患者18例;A HI为2.5~99.8次/h,平均(37.4±29.8)次/h,其中单纯打鼾轻度OSAS组19例(37.3%)、中重度OSAS组32例(62.7%)。中重度OSAS组ESS评分高于单纯打鼾轻度OSAS组[(9.9±5.1)分vs(6.6±4.2)分](P<0.05),中重度OSAS组RDI明显高于单纯打鼾轻度OSAS组[(49.4±23.1)次/h vs(6.8±4.5)次/h](P<0.001)。ESS评分与A H I相关性分析,r=0.435,P=0.002;单纯打鼾轻度OSAS组,RDI与AHI相关性分析,r=0.706,P=0.001;中重度OSAS组,RDI与AHI相关性分析,r=0.873,P=0.000;ESS评分≥9分患者,RDI与AHI相关性分析,r=0.967,P=0.000。ESS评分≥9分诊断中重度OSAS的敏感度45.2%,特异度78.9%;RDI≥15次/h诊断中重度OSAS的敏感度84.4%,特异度84.2%;ESS评分≥9分患者,RDI≥15次/h诊断中重度OSAS的敏感度100.0%,特异度100.0%。结论

OBJECTIVE To evaluate the value of Epworth sleepiness scale（ESS） combined with home-based portable monitoring（PM） in the diagnosis of patients with obstructive sleep apnea syndrome（OSAS）. METHODS Adult OSAS patients who visited Beijing Tongren Hospital and complained of snoring were included in this study.The overnight polysomnography（PSG） and the ESS were completed at the sleep center and the portable multichannel monitoring was completed within one week.Subjects were divided into two groups according to their apnea hypopnea index（AHI） of PSG： simple snoring or mild OSAS group（AHI15/h） and moderate-severe group（AHI≥15/h）. The ESS score, respiratory disturbance index（RDI） of PM and other parameters were compared and the correlation of AHI with ESS scores, RDI were analyzed. The sensitivity and specificity of ESS score≥9points, RDI≥15/h in the diagnosis of moderate-severe OSAS were calculated. RESULTS A total of 51 subjects were included in this study with 42 males（82.4%） and 9 females（17.6%）. Mean age was（43.8±10.8） years, and the mean body mass index was（27.9±4.5）kg/m2; ESS scored 1-24 points and mean（8.6±5.0） points, 18 cases with ESS score ≥9 points; AHI ranged between 2.5 and 99.8/h with a mean of（37.4±29.8）/h. There were 19（37.3%） and 32（62.7%）patients in snoring-mild group and moderate-severe group,respectively. There was significant difference for ESS scores between the two groups（9.9±5.1 vs 6.6±4.2 points, P 0.05）,RDI in moderate-severe OSAS group was significantly higher than that in snoring-mild group[（49.4±23.1）/h vs（6.8±4.5）/h, P 0.001）]. There was a positive correlation between the ESS score and PSG derived AHI（r =0.435,P =0.002）; the PM der ived RDI were signif icantly cor related with PSG der ived AHI in snoring-mild group（r =0.706, P =0.001）, moderate-severe group（r =0.873,P =0.000） and patients with ESS score ≥9 points（r =0.967,P =0.000）. At a PSG threshold AHI=15/h, the sensitivity and specificity for ESS score ≥9 points were 45.2% and 78.9%; the PM derived RDI≥15/h had a sensitivity and specificity of 84.4% and 84.2%, respectively; the sensitivity and specificity for each individual screening tool along with the combination of ESS and PM were 100.0% and 100.0%. CONCLUSION ESS combined with PM diagnostic method is a valuable measure for the diagnosis of moderate and severe OSAS patients.