OSAHS患者药物诱导睡眠内镜检查状态下咽喉部评分情况及其影响因素探讨

Study on throat scores of drug-induced sleep endoscopy and the influencing factors in patients with obstructive sleep apnea hypopnea syndrome

摘要:

目的 探究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者药物诱导睡眠内镜(DISE)检查状态下腭咽、口咽、舌根和会厌(VOTE)评分情况及其影响因素。方法 选取2019年3月—2021年3月石家庄市人民医院95例OSAHS患者，均行DISE检查，由两名经验相近的医师进行VOTE评分，采用组内相关系数评价两名医师评估OSAHS患者总VOTE评分的一致性。并比较不同临床参数患者VOTE评分，通过多元线性逐步回归模型分析VOTE评分的影响因素。结果 95例OSAHS患者4个阻塞平面总VOTE评分为(4.07±0.81)分，其中腭咽平面评分(1.49±0.13)分，以环形阻塞为主；口咽平面评分(1.38±0.15)分，均为左右阻塞；舌根平面评分(1.05±0.10)分，均为前后阻塞；会厌平面评分(0.15±0.02)分，均为左右阻塞；两名医师评估OSAHS患者腭咽平面评分的一致性相关系数为0.912(95%CI为0.846～0.972)，评估口咽平面评分的一致性相关系数为0.926(95%CI为0.871～0.984)，评估舌根平面评分的一致性相关系数为0.975(95%CI为0.891～0.990)，评估会厌平面评分的一致性相关系数为0.989(95%CI为0.912～0.998，P＜0.05)；不同体质指数(BMI)、麻醉诱导方法、Fridman分型、OSAHS严重程度、最低血氧饱和度OSAHS患者总VOTE评分比较，差异具有统计学意义(P＜0.05)；多元线性逐步回归分析结果显示，BMI、麻醉诱导方法、Fridman分型、OSAHS严重程度、最低血氧饱和度均为OSAHS患者总VOTE评分的影响因素(P＜0.05)。结论 OSAHS患者DISE检查状态下VOTE评分体系中，腭咽平面、口咽平面及舌根平面评分较高，总VOTE评分的影响因素包括BMI、麻醉诱导方法、Fridman分型、OSAHS严重程度、最低血氧饱和度。

Abstract:

Objective To investigate the velum (palatopharyngeal), oropharygneal, tongue base, and epiglottis (VOTE) scores and the influencing factors in drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Ninety-five OSAHS patients undergoing DISE in our hospital from March 2019 to March 2021 were selected, their VOTE scores of DISE were assessed by 2 physicians with similar experience, and the intra-group correlation coefficient (ICC) was used to evaluate the consistency of the total VOTE scores of OSAHS patients assessed by the 2 physicians. The VOTE scores of patients with different clinical profiles were also compared, and the influencing factors were analyzed by multiple linear stepwise regression model.Results The average total VOTE score of the 4 obstruction planes in the 95 patients was (4.07±0.81). Of them, the palatopharyngeal score (1.49±0.13) was dominated by circumferential obstruction, the oropharyngeal score (1.38±0.15) by left-right obstruction, the tongue base score (1.05±0.10) by anterior-posterior obstruction and the epiglottis score (0.15±0.02) by left-right. The ICC values for the two physicians assessing the palatopharyngeal, oropharyngeal, tongue base, and epiglottis scores were 0.912 (95%CI：0.846-0.972), 0.926 (95%CI：0.871-0.984), 0.975 (95%CI：0.891-0.990), and 0.989 (95%CI：0.912-0.998) respectively (P<0.05). The differences of total VOTE scores of patients with different body mass index (BMI), anesthesia induction method, Fridman staging, disease severity, and lowest oxygen saturation were statistically significant (P<0.05). The multiple linear stepwise regression analysis showed that the BMI, anesthesia induction method, Fridman typing, disease severity, and lowest oxygen saturation were all factors influencing the total VOTE scores (P<0.05).Conclusion In the assessment of OSAHS with DISE, higher scores are obtained in the palatopharyngeal, oropharyngeal, and tongue base planes in the VOTE scoring system, and the factors influencing the total VOTE score include BMI, anesthesia induction method, Fridman staging, disease severity, and lowest oxygen saturation.