摘要目的 探讨中国阻塞性睡眠呼吸暂停综合征(OSAHS)患者主客观嗜睡的一致性.方法 回顾性分析2010年7月至2014年7月因打鼾在四川大学华西医院睡眠中心就诊经整夜睡眠呼吸监测(PSG)确诊为OSAHS的1 660例患者的临床资料,所有患者均行日间多次睡眠潜伏期测试(MSLT)和采集Epworth嗜睡量表(ESS)评分.根据ESS评分的四分位数(5、8和13分)依次分为A(0 ～4分)、B(5～7分)、C(8～12分)和D(13 ～ 24分)四组,各406、325、443和486例;利用生存分析研究ESS评分与MSLT的一致性.结果 D组呼吸暂停低通气指数(AHI)显著高于其他三组[(58.7±26.1)比(36.8±24.2)、(42.6±26.7)、(45.7 ±26.6)次/h,均P＜0.05],D组平均睡眠潜伏期显著短于其他三组[(8.0±4.6)比(10.9±4.4)、(10.3±4.8)、(9.4±4.5)min,均P＜0.05].A～D四组患者Kaplan-Meier生存曲线差异有统计学意义(x2=77.76,P＜0.001),即ESS评分越高的组别,患者越易入睡(ESS评分越高的组别,同一时间点清醒患者的比例越低).以A组为参考,控制年龄、性别、AHI等混杂因素后,B、C、D组日间入睡的风险分别为1.05 (95％CI:0.90 ～ 1.22)、1.22(95％CI:1.07 ～ 1.40)和1.38(95％CI:1.20 ～ 1.60).结论 OSAHS患者的主客观嗜睡具有较好的一致性.

abstractsObjective To examine the association between subjective sleepiness and objective sleepiness in Chinese obstructive sleep apnea hypopnea syndrome (OSAHS) patients.Methods A total of 1 660 patients meeting the diagnostic criteria of OSAHS based on overnight polysomnography from West China Hospital,Sichuan University in the period from Jul 2010 to Jul 2014 were enrolled in the study.The Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT) were to evaluate subjective and objective sleepiness,respectively.The subjects were categorized into quartiles [A (0-4) (n =406),B (5-7) (n=325),C (8-12) (n=443),D(13-24) (n=486) groups] based on the ESS score distribution.Survival analysis was used to characterize the association between the ESS score and the mean sleep latency (MSL).Results The apnea hypopnea index (AH1) in D group was higher than other three groups [(58.7 ±26.1) vs (36.8 ±24.2),(42.6 ±26.7),(45.7 ±26.6) events/h,all P ＜0.05].The mean sleep latency in D group was shorter than other three groups [(8.0 ±4.6) vs (10.9 ±4.4),(10.3 ± 4.8),(9.4 ±4.5) min,all P ＜0.05].The Kaplan-Meier survivor functions across the ESS score quartiles were distinct and fourth quartiles were progressively associated with a greater tendency for falling asleep (x2 =77.76,P ＜0.001 by Log-rank test) in the daytime (The percentages of awaking patients in fourth quartiles were progressively lower at the same time).The adjusted hazard ratios for sleep onset during the MSLT for the group B,C and D were 1.05 (95％ CI:.90-1.22),1.22 (95％ CI:1.07-1.40),and 1.38 (95％ CI:1.20-1.60),respectively,comparing to group A.Conclusion Subjective report of daytime sleepiness is consistent with the objective sleepiness in OSAHS patients.