Tami T A, Duncan H J, Pfleger M
Department of Otolaryngology--Head and Neck Surgery, University of Cincinnati Medical Center, Ohio 45267-0528, USA.
Laryngoscope. 1998 Apr;108(4 Pt 1):508-13. doi: 10.1097/00005537-199804000-00009.
As the field of sleep medicine has evolved, the clinical implications of obstructive sleep apnea (OSA) in snoring patients have become well accepted. Recent advances in surgical therapy for snoring allow otolaryngologists to offer simple outpatient treatment to patients with this problem. However, because the incidence of OSA in snorers seeking medical attention is unknown, the appropriate pretreatment evaluation of these patients is a subject of continued debate. Ninety-four snoring patients were recruited for a study to determine the incidence of OSA in this highly selected population. Subjects answered an extensive sleep questionnaire to determine factors that might suggest a diagnosis of OSA. Level III ambulatory sleep studies were performed on each participant. The incidence of OSA in this group was 72% (42% severe and 30% mild to moderate). Twenty of the subjects with OSA also underwent formal level I sleep studies, and the diagnosis of OSA was confirmed in each instance. Although there was a relationship between body mass index and OSA and certain questions correlated with OSA, the sensitivity and specificity of these data alone or in combination were too low to recommend their use in lieu of a formal sleep study. Given the remarkably high incidence of OSA in this group, which may reflect that seen by otolaryngologists who treat snoring, a sleep study should be performed to diagnose OSA and institute therapy for this condition. Level III ambulatory monitoring devices may be the most cost-effective alternative for evaluating this high-risk population.
随着睡眠医学领域的发展，阻塞性睡眠呼吸暂停（OSA）在打鼾患者中的临床意义已得到广泛认可。打鼾手术治疗的最新进展使耳鼻喉科医生能够为有此问题的患者提供简单的门诊治疗。然而，由于寻求医疗帮助的打鼾者中OSA的发病率尚不清楚，对这些患者进行适当的术前评估仍是一个持续争论的话题。94名打鼾患者被招募进行一项研究，以确定这一经过高度筛选的人群中OSA的发病率。受试者回答了一份详尽的睡眠问卷，以确定可能提示OSA诊断的因素。对每位参与者进行了三级动态睡眠研究。该组中OSA的发病率为72%（42%为重度，30%为轻度至中度）。20名OSA受试者还接受了正式的一级睡眠研究，每次均确诊为OSA。尽管体重指数与OSA之间存在关联，且某些问题与OSA相关，但单独或综合使用这些数据的敏感性和特异性都太低，不足以推荐用它们来替代正式的睡眠研究。鉴于该组中OSA的发病率极高，这可能反映了治疗打鼾的耳鼻喉科医生所见到的情况，因此应进行睡眠研究以诊断OSA并对该疾病进行治疗。三级动态监测设备可能是评估这一高风险人群最具成本效益的选择。
