ESS及MSLT对评价OSAHS患者白天嗜睡的价值探讨

发布时间：2018-02-25 16:14

  本文关键词： 白天嗜睡 Epworth评分量表 白天多次小睡潜伏实验 平均入睡潜伏期 阻塞性睡眠呼吸暂停低通气综合症　出处：《苏州大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的：通过对OSAHS患者进行Epworth评分以及MSLT检测,探讨ESS、MSLT在评价OSAHS患者白天嗜睡及辅助诊断中的价值。 方式：选取2007年08月至2010年12月因打鼾至我院睡眠中心行多导睡眠监测(polysomnography, PSG)的患者83例,平均年龄(54.81士14.19)岁,体块指数(body mass index, BMI) (25.83±4.22)kg/m2,其中男性63例,女性20例,对上述患者,分别进行Epworth评分及白天多次小睡潜伏实验(MSLT)。根据AHI值将其分为单纯鼾症组(AHI5,n=23), OSAHS轻中度组(5≤AHI≤40,n=22), OSAHS重度组(AHI40,n=38),采用独立样本T检验比较各组ESS、MSL、睡眠结构参数及低氧参数的差异,其中睡眠结构参数包括：睡眠潜伏期、总睡眠时间、睡眠效率、1期睡眠比例、2期睡眠比例、慢波睡眠比例、REM睡眠比例、REM睡眠潜伏期及微觉醒指数,低氧参数包括氧减指数、最低血氧饱和度、AHI；用非参数相关法分析ESS及MSL与上述PSG参数之间的相关性；用偏相关法分析MSL与ESS的相关性,同时以MSL10min为金标准诊断白天嗜睡,评价Epworth量表对OSAHS患者白天嗜睡的诊断价值。并进一步将患者根据MSL分为正常组(MSL≥10min,n=39),轻中度嗜睡组(5min≤MSL10min,n= 32),重度嗜睡组(MSL5min,n=12),比较三组间ESS评分的差异。以AHI≥5为诊断OSAHS标准,评价Epworth量表筛选OSAHS的价值。 结果：1.轻中度OSAHS组MSL(10.98±5.18min)较单纯鼾症组(14.09±3.43 min)显著减少(P0.05),重度OSAHS组MSL(6.83±3.12min)较轻中度组缩短(P0.05)。ESS各组之间均无明显统计学意义。2.MSL与夜间PSG监测参数中睡眠结构(睡眠潜伏期、总睡眠时间、睡眠效率、2期睡眠比例、慢波睡眠比例、REM睡眠比例、REM睡眠潜伏期、微觉醒指数)具有相关性(P0.01,或0.05),与低氧参数(最低血氧饱和度、氧减指数、AHI)具有相关性(P0.01,或0.05)；而在上述参数中,ESS与慢波睡眠比例、REM潜伏期、REM期比例无相关性。3.排除年龄、体重指数因素,MSL与ESS间有显著负相关性(r=-0.369,P0.01),以MSL10min为金标准判断OSAHS患者白天嗜睡,ESS诊断白天嗜睡的ROC曲线下面积为0.762。不同嗜睡程度组之间比较,ESS评分呈逐渐增高趋势,重度嗜睡组ESS评分(17.58±3.99)较正常组(8.36±5.84)明显增高(P0.05)。以AHI5为OSAHS诊断标准,ESS筛选OSAHS的曲线下面积为0.775。 结论：MSLT与ESS相比,更能准确反映OSAHS患者的日间嗜睡程度,且随着OSAHS严重程度的增加,患者嗜睡倾向加重；ESS可用于评价OSAHS患者白天嗜睡情况,对OSAHS有一定初筛作用,但误诊率偏高。
[Abstract]:Objective: to evaluate the value of Epworth score and MSLT in the evaluation of daytime sleepiness and auxiliary diagnosis of OSAHS patients. Methods: from August 2007 to December 2010, 83 patients with polysomnography (PSG) underwent polysomnography from snoring to sleep center of our hospital. The mean age was 54.81 卤14.19) years. The body mass index (BMI) was 25.83 卤4.22 kg / m2, including 63 males and 20 females. According to the AHI value, the patients were divided into simple snoring group, OSAHS mild to moderate group, OSAHS mild and moderate group, and OSAHS severe group. The differences of ESS MSLs, sleep structure parameters and hypoxic parameters were compared by independent sample T test. Among them, sleep structure parameters include: sleep latency, total sleep time, sleep efficiency, sleep rate, REM sleep latency and microarousal index, and hypoxia parameters include oxygen reduction index, REM sleep latency and microarousal index, slow wave sleep ratio and REM sleep ratio. The correlation between ESS and MSL and the above-mentioned PSG parameters was analyzed by non-parametric correlation method, the correlation between MSL and ESS was analyzed by partial correlation method, and the daytime sleepiness was diagnosed by using MSL10min as the gold standard. To evaluate the diagnostic value of Epworth scale for daytime somnolence in OSAHS patients, and to further divide the patients into three groups according to MSL: normal group, mild to moderate somnolence group, 5 minutes 鈮，

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