Real-time CT of upper airway in patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the technology and clinical application of real-time CT scan in obstructive sleep apnea hypopnea syndrome during awake and drug induced sleep state.</p><p><b>METHODS</b>Sixty-two patients with OSAHS diagnosed by polysomnography underwent 256 layer spiral CT scan during awake and drug-induced sleep apnea state, and multiplanar reconstruction and volume rendering of computed tomography images were performed. To observe the dynamic changes of upper airway and locate the sites of airway obstruction in patients with OSAHS, the minimum section area, diameter and volume of pharynx cavity were measured on reconstructed 3-dimensional computed tomography.</p><p><b>RESULTS</b>Real-time CT scans were completed successfully in all of the patients. It was revealed that airway obstruction frequently occurred at retropalatal and retroglottal region. Real-time CT scans revealed 29 cases with airway obstruction at isolated retropalatal region, 19 cases with airway obstruction at retropalatal and retroglottal region simultaneously, 6 cases with airway obstruction at retropalatal and epiglottal region simultaneously, 7 cases with airway obstruction at retropalatal, retroglottal and retroglottal region simultaneously, 1 case without airway obstruction. There was no airway obstruction at retroglottal or retroglottal region isolatedly. Rate of single region airway obstruction was 46.8% (29/62), and rate of multiple regions airway obstruction 51.6% (32/62). The real-time CT results showed that starting from Friedman tongue position I to IV, the percentage of obstruction at retroglottal and (or) retroglottal region simultaneously were increasing, the percentage of obstruction were 0/6, 8/25, 13/20, 11/11, respectively (χ(2) = 22.00, P < 0.005). The minimum section area, volume, minimum anteroposterior diameter and left-right diameter of pharynx cavity between awake and drug-induced sleep apnea state had statistically significant difference in all region.</p><p><b>CONCLUSIONS</b>Real-time CT scans in drug-induced sleep state could get more information about the anatomical and pathological changes of upper airway, providing relatively objective morphological basis for the diagnosis and treatment of patients with OSAHS. Therefore, real-time CT scans have important value in practical application.</p>

Reliability and validity of the simplified Chinese version of Epworth sleepiness scale / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the reliability and validity of the simplified Chinese version of Epworth sleepiness scale(ESS).</p><p><b>METHODS</b>Five hundred and eighty-five patients with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and 103 OSAHS patients who underwent operations were included in this study. The ESS was filled before polysomnography (PSG) monitoring under the direction of professional technicians. The patients who underwent operations did both PSG and ESS tests more than 6 months after operation. Fifty-one patients who underwent PSG at our hospital from July to August, 2010 were chosen to assess the ESS test-retest reliability on two separate occasions at least more than one week.</p><p><b>RESULTS</b>The total Cronbach's Alpha of ESS was 0.814. The test-retest reliability of ESS total scores was 0.679 and for each item was from 0.473 to 0.698(P < 0.01). Split-half reliability was 0.817 (P < 0.01). In the analysis of discriminant validity with apnea hypopnea index (AHI), the ESS total scores and each item's scores had significant differences in severity in OSAHS patients and simple snoring patients (P < 0.05), and this was also true in different degrees of lowest saturation of arterial oxygen (LSaO(2)) patients and normal LSaO(2) patients (P < 0.05). The factor analysis of construct validity showed that 4 factors were extracted. The cumulative proportion was 74.270%. The loading was higher than 0.4 among every item. The correlation coefficiency of overall ESS scores and each item's scores was relatively high except the last item. The ESS had low consistency with clinical diagnosis(κ = 0.099, P < 0.01) and the predictive validity was not good (r = 0.138, P < 0.01).As for 103 patients who had operations, the initial assessment of total ESS scores were 15.0[10;20] (M[P(25); P(75)]), and improved to 4[1;6] after operation. The patients who got effective results had significant difference in the total ESS scores before and after operation (Z = -7.528, P < 0.01), so was the patients who got ineffective results (Z = -4.382, P < 0.01) .</p><p><b>CONCLUSIONS</b>The simplified Chinese version of ESS had a good reliability and validity. It can be used to evaluate the chance of dozing in the daytime.</p>