摘要
目的探讨中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者白天过度嗜睡(EDS)程度与持续气道正压通气(CPAP)治疗依从性的关系。方法选择2010年1月—2011年6月本院经多导睡眠图(PSG)确诊并建议CPAP治疗的中重度OSAHS患者91例。以能够每晚4 h且每周5 d以上进行CPAP治疗且坚持≥2个月的患者为CPAP依从组(37例),否则为CPAP非依从组(54例)。患者EDS程度以Epworth嗜睡评分量表(ESS)评分表示。分析比较两组间的一般情况、ESS评分和PSG结果,采用Logistic回归分析和受试者工作特征(ROC)曲线分析ESS评分与CPAP治疗依从性的关系。结果 CPAP依从组和CPAP非依从组的性别、年龄、体质指数(BMI)和呼吸暂停低通气指数(AHI)、最低手指脉搏血氧饱和度(LSpO2)、最长呼吸暂停时间(Tmax)比较,差异均无统计学意义(P>0.05);而两组ESS评分比较,差异有统计学意义(P<0.01)。Logistic回归分析显示,ESS评分是影响CPAP治疗依从性的独立危险因素,即较高的ESS评分可增加CPAP治疗的依从性〔OR=1.53,95%CI(1.26,1.85)〕。ROC评价ESS评分对患者CPAP治疗依从性,曲线下面积(AUC)为0.798,95%CI(0.709,0.886),P<0.01;ESS评分>13分的中重度OSAHS患者能够依从CPAP治疗的敏感性为51.4%,特异性为83.3%,阳性预测值为68.0%,阴性预测值为71.0%。结论中重度OSAHS患者CPAP治疗的依从性与EDS有关,ESS评分较高患者CPAP治疗的依从性较好。
Objectives To investigate the relationship between excessive daytime sleepiness （EDS） and continuous positive airway pressure （CPAP） treatment compliance in patients with moderate to severe obstructive sleep apnea and hypopnea syndrome （OSAHS）. Methods A total of 91 patients with moderate to severe OSAHS prescribed using CPAP treatment from Jan 2010 to Jun 2011 were divided, based on whether insisting on 4 h CPAP treatment 5 d in every week for 2 months, into groups compliance （ n = 37 ） and non - compliance （ n = 54 ）. EDS degree was expressed by Epworth sleepiness scale （ESS）. General conditions, ESS and PSG outcome were analyzed. Logistic regression and receiver operating curve were used to analyze the relationship of ESS to CPAP treatment compliance. Results No significant difference was noted between 2 groups in PSG re- sults such as gender, age, body mass index （BMI） , apnea hypopnea index （AHI）, lowest SpO2 （LSpO2 ） , the longest apnea time （Tmax） （ P 〉 0. 05 ）, but there was in ESS （ P 〈 0.01 ）. By logistic recession, ESS was an independent risk factor influ- encing CPAP treatment compliance, namely higher ESS increased compliance [ OR = 1.53, 95% CI （ 1.26, 1.85） 1- By ROC, area under curve （AUC） was 0. 798, 95% CI （0. 709 -0. 886, P 〈0. 01 ）. Based on ROC, ESS cut - off value for pre- dicting CPAP treatment compliance was 〉 13, its sensitivity and specificity were 51.4% , 83.3% , respectively, and the positive predictive value and negative were 68.0%, 71.0% , respectively. Conclusion The CPAP treatment compliance is associ- ated with EDS in patients with moderate to severe OSAHS. Patients with higher ESS score have a better CPAP treatment compli- ance.
出处
《中国全科医学》
CAS
CSCD
北大核心
2012年第26期2993-2995,共3页
Chinese General Practice
基金
首都医科大学基础-临床科研合作基金(09JL17)
关键词
睡眠呼吸暂停
阻塞性
白天过度嗜睡
连续气道正压通气
依从性
Sleep apnea, obstructive
Excessive daytime sleepiness
Continuous positive airway pressure
Compliance
