嗜睡中医临床评价初步研究

摘要

This project aims to find a way to evaluate somnolence from clinical viewpoint of Traditional Chinese Medicine (TCM).Finally,we will develop a TCM syndrome scale for evaluating somnolence in adults with obstructive sleep apnea-hypopnea syndrome (OSAHS).Method:Philological method and clinical method were applied in our research.The preliminary TCM evaluating scale was used to test patients randomly with OSAHS in sleep medical center and ENT department of Guang' anmen Hospital,China Academy of Chinese Medical Sciences.Moreover,modern evaluating methods were combined,such as Daytime Sleepiness Scales,Epworth Sleepiness Score,Stanford Sleepiness Scale (SSS),polysomnography(PSG)),which help to evaluate from subjective and objective perspectives.Result:The correlation coefficient between the score of TCM evaluating scale of somnolence and AHI demonstrated by PSG data:r =0.925 (P ＜ 0.05)o The result suggests a strong positive correlation between them.The correlation coefficient between the score of TCM evaluating scale of somnolence and minimum SaO2 (％)demonstrated by PSG data:r =-0.700 (P ＜ 0.05),which suggests a negative correlation between them.The correlation coefficient between the score of TCM evaluating scale of somnolence and Epworth sleepiness scale:r =0.768 (P ＜ 0.05),which implies positive correlation between them.Parallel validity analysis proves that TCM evaluating scale of somnolence has a good parallel validity.The correlation coefficient between score of TCM evaluating scale of somnolence and SSS:r =0.394 (P ＜ 0.05),which demonstrated a compared weak positive correlation.Conclusion:Score of TCM evaluating scale of somnolence has positive correlation with score of ESS and SSS.The result proves its validity and reliability which entail its ability to evaluate sleepiness degree of patients with OSAHS.TCM evaluating scale of somnolence is also useful to evaluate other sings and symptoms of OSAHS patients.By analyzing these symptoms,the common TCM syndromes of OSAHS include damp-heat syndrome,phlegm and blood stasis syndrome,especially the compound of them.%目的:为了寻求一种从中医临床角度评价嗜睡的方法,旨在建立评价成人阻塞性睡眠呼吸暂停-低通气综合征(Obstructive Sleep Apnea-Hypopnea Syndrome,OSAHS)患者嗜睡状态的中医证侯量表.方法:运用文献学方法,结合临床医学方法,运用初步研制的嗜睡中医评价量表在中国中医科学院广安门医院心理睡眠医学科及耳鼻喉科门诊中随机抽取OSAHS嗜睡患者进行调研,结合现代医学检查手段,如嗜睡量表:Epworth嗜睡评分量表、斯坦福嗜睡量表(SSS)、多导睡眠监测仪(Polysomnography,PSG)等从主客观两方面进行评价.结果:102例OSAHS患者的嗜睡中医评估量表与PSG结果中的AHI比较相关系数r=0.925(P ＜0.05)有统计学意义,故二者存在较强正相关；嗜睡中医评估量表与PSG结果中的最低Sa02(％)比较相关系数r=-0.700(P ＜0.05)有统计学意义,故二者存在负相关；嗜睡中医评估量表评分与Epworth嗜睡评分比较相关系数r=0.768(P＜0.05)有统计学意义,二者存在适度正相关且r=0.768,通过平行效度分析可知中医嗜睡量表有较好的平行效度.嗜睡中医评估量表与SSS嗜睡评分比较相关系数为0.394(P ＜0.05)有统计学意义,二者存在较弱正相关.结论:嗜睡中医评估量表与Epworth嗜睡评分(ESS)、斯坦福嗜睡量表(SSS)比较分析均呈正相关性,有较好的平行效度,能有效地评价OSAHS患者的嗜睡程度.嗜睡中医评估量表还能评价出0SAHS患者的其他一系列症状和体征,根据这些症状和体征归纳出OSAHS患者常见的证型为痰湿证、湿热证、血瘀证,尤其以痰湿血瘀复合型最多见.