氧减指数联合ESS评分对阻塞性睡眠呼吸暂停低通气综合征的诊断价值探讨  

The Diagnosis Value of the Combination of Oxygen Desaturation Index and Epworth Sleepiness Scale in Obstructive Sleep Apnea-Hypopnea Syndrome

作　　者：黄志华[1,2] 陈晓[1,2] 黄建钗[1,2] 王碧瑛[1,2] 

机构地区：[1]福建医科大学附属第一医院呼吸内科福建省睡眠呼吸疾病诊治中心 [2]福建医科大学呼吸系病研究室,福州350005

出　　处：《福建医科大学学报》2015年第1期24-28,共5页Journal of Fujian Medical University

摘　　要：目的探讨氧减指数(ODI)联合Epworth嗜睡量表(ESS)评分对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的临床诊断价值。方法纳入鼾症患者469例,根据呼吸暂停低通气指数(AHI)分为单纯鼾症组及轻度、中度、重度OSAHS组,比较各组间ESS评分及多导睡眠图结果。做出ODI、ESS的受试者工作特效(ROC)曲线。采用Logistic回归和ROC曲线对ODI联合ESS评分做ROC曲线分析。结果 (1)各组之间ESS评分、ODI、Ts90%、LSaO2、MSaO2差别均有统计学意义(P均=0.000)。(2)所有患者的ESS评分、ODI、Ts90%、LSaO2、MSaO2均与AHI显著相关(P均=0.000),以ODI与AHI的相关性最好(r=0.917)。(3)分别以ODI≥5,10,15,20次/h为诊断OSAHS的标准,随ODI升高,敏感度下降,特异度上升,阳性预测值升高,阴性预测值下降。以ODI≥5次/h来诊断OSAHS的敏感度为92.8%,特异度为82%,阳性预测值为97.7%,阴性预测值为57.7%。(4)以ODI≥5次/h结合ESS评分≥9分来诊断OSAHS的敏感度为92.6%,特异度为86.0%,阳性预测值为98.2%,阴性预测值为61.4%。结论 ODI≥5次/h结合ESS评分≥9分对OSAHS的诊断有较大的价值,可作为OSAHS的初筛诊断标准。Objective To study the diagnosis value of the combination of oxygen desaturation index（ODI）and epworth sleepiness scale（ESS）score in obstructive sleep apnea-hypopnea syndrome（OSAHS）. Methods A total of 469 patients who complained snoring and visited our Sleep-Disordered Breathing Clinic Center were enrolled and divided into simple snore,slight OSAHS,moderate OSAHS,and severe OSAHS group by apnea hypopnea index（AHI）. We analyzed the ESS and result of polysomography among the four groups. We then created receiver operating characteristic（ROC）curves for ODI and ESS. We also analyzed the ROC curves of ODI combined with ESS score using logistic regression and ROC curve. Results The ESS,ODI,Ts90%,LSaO2,MSaO2 had statistically significant difference among four groups（all P=0.000）. There were statistically significant correlation between ESS,ODI,Ts90%,LSaO2,MSaO2 and AHI（all P=0.000）,while the correlation between ODI and AHI was the strongest（r=0.917）. When ODI values≥5,10,15,20times/h respectively were used as the criteria for diagnosis of OSAHS,with the increase of ODI,sensitivity decreased,specificity increased,positive predictive value increased,while the negative predictive value decreased. When ODI≥5times/h was chosen as OSAHS diagnostic cut off point,the sensitivity,specificity,the positive predictive value and the negative predictive value reached 92.8%,82%,97.7% and 57.7%respectively. When ODI≥5times/h combined with ESS≥9was chosen as the diagnostic standard,the sensitivity,specificity,the positive predictive value and the negative predictive value reached 92.6%,86.0%,98.2%and 61.4%respectively.Conclusions ODI≥5times/h combined with ESS≥9had the value for the diagnosis of OSAHS,therefore it could be used widely for OSAHS patients screening using family portable oximeter and ESS.

关 键 词：多道睡眠描记术 睡眠呼吸暂停 阻塞性 睡眠呼吸暂停综合征 血氧测定法 氧 

分 类 号：R766[医药卫生—耳鼻咽喉科]