The Correlation And Clinical Applications Between Epworth Sleepiness Scaleand Hypertension In Obstructive Sleepapnea-hypopnea Syndrome Patients

OBJECTIVE To investigate the correlation between Epworth sleepinessscale and hypertension in obstructive sleep apnea-hypopnea syndrome patients，to search a simple method for screening OSAHS in hypertensive patients. Toprovide a theoretical basis for hypertensive patients whether to take the polys-omnography examination.METHOD Between May2009and October2011,1802consecutive patientswho due to snoring, sleep apnea, hypertension, and diabetes in the GuangxiZhuang Autonomous Region People’s Hospital and Liuzhou People’s Hospitalwere recruited. BP assessments were evaluated at two time points (before goingto bed and after wake up) under standardized conditions.Anthrop-ometricmeasurements, such as height, weight, neck circumference, abdominalcircumference were measured. ESS score was calculated for each participantand nocturnal PSG was performed.Subjects were classified into non-OSAHSgroup and OSAHS group based on the apnea-hypopnea index(AHI) from PSG. Further OSAHS group were classified into mild OSAHS group,moderateOSAHS group and severe OSAHS group. To statistical describe and analyze thegeneral information and to compare the prevalence of hypertension in differentc-es of each group.Statistical analysis the correlation among ESS scores and age,sex, BMI, AHI, BP profile, minimum oxygen saturation; analysis the correlationamong AHI and the above parameters. Extract department of CardiovascularMedicine outpatient or hospitalized patients who due to hypertension.With PSGdiagnosis as the gold standard, using fourfold table to calculate theSensitivity,Specificity, Youden Index for the ESS screening OSAHS.UsingReceiver Operating Characteristic Curve (ROC) to find the bestest score forscreening OSAHS in hypertensive patients with who come from cardiovascularoutpatients and hospitalized patients due to high blood pressure. SPSS17.0software package was used for data processing.RESULT (I),1802subjects were recruited,1475males (81.85%),327females(18.15%).The mean age of them is47.87±14.24years, BMI26.79±3.77kg/m2,the ESS scores8.00±5.10points, AHI25.93±24.83events/hour. OSAHS groupwas1365(75.7%), the ESS scores was8.49±5.21points, non-OSAHS groupwas437(24.3%), the ESS scores was6.48±4.41points, differences was statisti-cally significant (F=52.49, P<0.05);(II), Severe OSAHS group obesity account-ed for52%, moderate30.8%, mild27.9%, significant difference (P<0.01)amo-ng severe OSAHS and mild to moderate group;(III), the prevalence ofhypertension in OSAHS was46.8%, non-OSAHS was27.7%, both were signif-icantly different (χ~2=49.64,P<0.01);(IV), the ESS scores gradually increasedwith the OSAHS severity (ESS scores were:7.32±4.64,8.03±5.11,9.42±5.42),differences were statistically significant in the OSAHS severity categories(P<0.05);(V), By bivariate correlation analysis, the ESS scores and BMI, and AHI, diastolic blood pressure, mean pressure before going to bed, systolic bloodpressure, diastolic blood pressure, mean pressure after wake up were positivecorrelation(r=0.218、0.271、0.109、0.091、0.178、0.278、0.253, respectively,allP<0.01), with the lowest oxygen saturation at night into a negative correlation(r=-0.279,P<0.01), gender (r=-0.111,P<0.01), age (P>0.05). After controllingfor sex, BMI, AHI, at night the lowest oxygen saturation after partial correlationanalysis, the ESS score and diastolic blood pressure and mean pressure afterwake up were positive correlation（r=0.163,0.147, respectively,both P<0.05);(VI),With the ESS9as the diagnostic point for screening OSAHS inhypertensive patients,the sensitivity and specificity were45.6%,73.2%, respe-ctively. ROC curve to screen OSAHS, the area under the ROC curve was0.698,the sensitivity in6points,7points,8point was74.5%,72.5%,56.9%, respect-tively,specificity was69.0%,72.4%,75.9%,Youden Index was0.435,0.449,0.328,the sensitivity and specificity of7points greater than70%,and the YoudenIndex was the highest.CONCLUSION ESS scores is meaningful for judgment OSAHS severity.ESS score, diastolic and mean blood pressure after wake up were positivecorrelation.ESS can be used for screening OSAHS in hypertensive patients.Recommending ESS7points as diagnostic point for screening OSAHS inhypertensive patients.