CAJ | 학술논문

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 OSA HS 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、T s90％、LSaO2、M SaO2差别均有统计学意义（ P均＝0．000）。（2）所有患者的 ESS评分、ODI、T s90％、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OSA HS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OSA HS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OSA HS的初筛诊断标准。
목적：탐토양감지수（ODI）연합Epworth기수량표（ESS）평분대조새성수면호흡잠정저통기종합정（OSAHS）환자적림상진단개치。방법납입한증환자469례，근거호흡잠정저통기지수（AHI）분위단순한증조급경도、중도、중도 OSA HS 조，비교각조간 ESS 평분급다도수면도결과。주출 ODI、ESS 적수시자공작특효（ROC）곡선。채용Logistic회귀화ROC곡선대ODI연합ESS평분주ROC곡선분석。결과（1）각조지간ESS평분、ODI、T s90％、LSaO2、M SaO2차별균유통계학의의（ P균＝0．000）。（2）소유환자적 ESS평분、ODI、T s90％、LSaO2、MSaO2균여AHI현저상관（P균＝0．000），이ODI여AHI적상관성최호（r＝0．917）。（3）분별이ODI≥5，10，15，20차／h위진단OSA HS적표준，수ODI승고，민감도하강，특이도상승，양성예측치승고，음성예측치하강。이ODI≥5차／h래진단OSA HS적민감도위92．8％，특이도위82％，양성예측치위97．7％，음성예측치위57．7％。（4）이ODI≥5차／h결합ESS 평분≥9분래진단 OSAHS적민감도위92．6％，특이도위86．0％，양성예측치위98．2％，음성예측치위61．4％。결론 ODI≥5차／h결합ESS평분≥9분대OSAHS적진단유교대적개치，가작위OSA HS적초사진단표준。
Objective To study the diagnosis value of the combination of oxygen desaturation in‐dex (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 OSA HS group by apnea hypopnea index (A HI) . We analyzed the ESS and result of polyso‐mography 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 regres‐sion and ROC curve . Results The ESS ,ODI ,Ts90% ,LSaO2 ,MSaO2 had statistically significant differ‐ence 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 ,20 times/h respectively were used as the crite‐ria 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≥5 times/h was cho‐sen as OSA HS 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≥5 times/h combined with ESS≥9 was chosen as the diagnostic standard ,the sensitivity ,specificity ,the positive pre‐dictive value and the negative predictive value reached 92 .6% ,86 .0% ,98 .2% and 61 .4% respectively . Conclusions ODI≥5 times/h combined with ESS≥9 had the value for the diagnosis of OSA HS ,therefore it could be used widely for OSAHS patients screening using family portable oximeter and ESS .