阻塞性睡眠呼吸暂停低通气综合征患者白天过度嗜睡的影响因素及其列线图模型构建  

Infuencing factors of excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome andconstruction of column chart model

作　　者：顾婷婷 邱月 徐泓 吕露 吴春晓 管佳怡 陈莉[1] GU Tingting;QIU Yue;XU Hong;LYU Lu;WUChunxiao;GUAN Jiayi;CHEN Li(Department of Otolaryngology Head and Neck Surgery,the Second People's Hospital of Huai'an,Huai'an,Jiangsu,223002,China)

机构地区：[1]淮安市第二人民医院耳鼻喉头颈外科,江苏淮安223002

出　　处：《中国耳鼻咽喉头颈外科》2023年第11期727-731,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：2017年度省第五期“333工程”科研资助立项项目(BRA2017239);江苏省卫计委2017年度立项面上课题(H2017012);淮安市重点研发计划(社会发展)(HAS201611)。

摘　　要：目的探析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者白天过度嗜睡(excessive daytime sleepiness,EDS)的影响因素,并建立预测EDS的列线图模型。方法选取2021年10月~2023年5月在淮安市第二人民医院就诊的263例OSAHS患者,采用Epworth嗜睡量表(ESS)对其进行评定,并分成EDS组(ESS>10分)和非EDS组(ESS≤10分)。获取患者一般资料、体格检查资料及睡眠监测参数行单因素分析,利用Logistic回归筛查出EDS的影响因素。通过R软件中的rms包绘制OSAHS患者EDS的列线图模型,并应用ROC曲线下面积(AUC)、校准曲线对模型的区分度与准确度开展评价。结果82例OSAHS患者发生EDS,发生率为31.18%;EDS组性别、体重指数(BMI)、睡眠效率、呼吸暂停低通气指数(AHI)、最低氧饱和度(LSaO2)、平均血氧饱和度(ASaO2)、血氧饱和度低于90%的时间占监测总时间的百分比(TS90%)、微觉醒指数、非快动眼睡眠的N3期比例和非EDS组比较存在差异(P均<0.05);Logistic回归分析结果显示,OSAHS患者发生EDS的影响因素主要有BMI、TS90%、微觉醒指数、N3期比例4项;根据4项因素构建预测OSAHS患者发生EDS的列线图模型,内部验证结果显示,AUC为0.846(95%CI=0.798~0.895),预测OSAHS患者发生EDS的校准曲线和理想曲线趋近,且拟合优度HL检验χ^(2)=6.251,P=0.619。结论根据BMI、TS90%、微觉醒指数、N3期比例构建的列线图模型可对OSAHS患者发生EDS的风险起到良好预测作用。OBJECTIVE To explore the influencing factors of excessive daytime sleepiness(EDS)in patients with obstructive sleep apnea hypopnea syndrome(OSAHS),and to establish a column chart model to predict EDS.METHODS From October 2021 to May 2023,263 OSAHS patients who visited the Second People's Hospital of Huai'an were collected and evaluated using the Epworth Sleepiness Scale(ESS),then they were grouped into an EDS group(ESS>10 points)and a non EDS group(ESS≤10 points).General information,physical examination data,and sleep monitoring parameters were obtained for univariate analysis,and the influencing factors of EDS were screened using logistic regression.The column chart model of EDS of OSAHS patients was drawn through the rms package in R software,and the differentiation and accuracy of the model were evaluated by the area under the receiver operating characteristic(AUC)and calibration curve.RESULTSSEighty-two OSAHS patients developed EDS,with an incidence rate of 31.18%;Gender,body mass index(BMI),sleep efficiency,apnea hypopnea index(AHI),lowest oxygen saturation(LSaO2),average oxygen saturation(ASaO2),percentage of time of blood oxygen saturation below 90%to total monitoring time(TS90%),micro arousal index,proportion of non rapid eye movement sleep N3 phase in EDS group were different from those in non EDS group(P<0.05);the results of Logistic regression analysis showed that the main influencing factors for the occurrence of EDS in OSAHS patients included BMI,TS90%,micro arousal index,and N3 phase proportion;a column chart model was constructed based on four factors to predict the occurrence of EDS in OSAHS patients,the internal validation results showed that the AUC was 0.846(95%CI=0.798~0.895),the calibration curve and ideal curve for predicting the occurrence of EDS in OSAHS patients approached,and the goodness of fit HL test χ^(2)=6.251,P=0.619.CONCLUSION A column chart model constructed based on BMI,TS90%,micro arousal index,and N3 phase ratio can effectively predict the risk of EDS in OSAHS patients.

关 键 词：睡眠呼吸暂停 阻塞性 回归分析 列线图 白天过度嗜睡 

分 类 号：R766[医药卫生—耳鼻咽喉科]