Epworth嗜睡量表评价阻塞性睡眠呼吸紊乱病情程度的价值

目的探讨Epworth嗜睡量表（Epworth sleepiness scale，ESS）评价阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）病情严重程度的价值。方法分析总结2000年1月至2003年12月4年间登记资料完整的620例疑似OSAHS成人患者的多道睡眠监测仪（polysomnography，PSG）监测结果。男556例，女64例；年龄21～79岁，中位数45．0岁；身高147～178cm，中位数172．0cm；体重50～130kg，中位数82．0kg；体重指数18．5～42．9，中位数28．0；呼吸暂停低通气指数（apnea-hypopnea index，AHI）0～126．1次／h，中位数37．2次／h；最低血氧饱和度（lowest arterial oxygen saturation，LAST）0．21～0．93，中位数0．75；Epworth嗜睡分值（ESS）0～24，中位数13．0。符合OSAHS者513例，单纯鼾症107例。比较ESS与AHI和LSAT的关系，并进行统计学处理。结果Pearson相关分析发现，ESS与OSAHS患者的AHI及LSAT的相关系数分别为0．314和-0．312，尽管统计学检验P〈0．05，但相关性很低。单纯鼾症以及轻、中度OSAHS各组间ESS中位数值差异无统计学意义（P〉0．05）；重度OSAHS组ESS中位数值为14．0，高于单纯鼾症以及轻、中度OSAHS组（分别为10．0、10．0和11．5），P〈0．05。按最低血氧饱和度为依据划分低氧血症各组，发现无低氧血症组以及轻、中度低氧血症各组间ESS中位数值差异无统计学意义（P〉0．05），重度低氧血症组ESS中位数值为16．0，高于无低氧血症组以及轻、中度低氧血症组（分别为10．0、12．0和11．0），P〈0．05。结论ESS作为评估OSAHS病情严重程度的指标的价值不大，需要研究制定适合中国人的评定OSAHS患者的嗜睡评分标准。

Value of Epworth sleepiness scale in assessment the degree of sleep disordered breathing

OBJECTIVE: To study the value of Epworth sleepiness scale in assessment of obstructive sleep apnea hypopnea syndrome (OSAHS) severity. METHODS: The polysomnography (PSG) data of 620 suspected OSAHS patients from Jan. 2000 to Dec. 2003 were retrospectively analyzed. There were 556 males and 64 females, and their age ranged from 21 to 79 years (median 45.0 years). Of the all 620 patients, the median of the weight was 82.0 kg ( range 50 to 130 kg), median of height was 172.0 cm (range 147 to 178 cm), median of body mass index was 28.0 (range 18.5 to 42.9), median of apnea-hypopnea index (AHI) was 37.2 (range 0 to 126.1), median of lowest arterial oxygen saturation (LSAT) was 0.75 (range 0.21 to 0.93), median of ESS was 13.0 (range 0 to 24). OSAHS was diagnosed in 513 patients and simple snorer was diagnosed in 107 patients by PSG. All the patients filled in ESS questionnaire in sleep disorder centre before PSG. RESULTS: The correlation coefficients of the ESS and AHI, LSAT was -0.314 and -0.312 respectively (P <0. 05). The median of ESS in severe OSAHS group was higher than that in simple snorer, mild and moderate OSAHS groups (P < 0.001), but no difference was found among the simple snorer, mild and moderate OSAHS groups (P < 0.05). The median of ESS in severe hypoxemia group was higher than that in no, mild and moderate hypoxemia groups (P < 0.001), but no difference was found among no, mild and moderate hypoxemia groups (P > 0.05). CONCLUSIONS: The Epworth sleepiness scale has little value in assessment of OSAHS severity. A new sleepiness scale method which is suitable for Chinese should be made.