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目的 探讨清醒维持试验(maintenance of wakefulness test,MWT)作为阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)飞行人员医学鉴定评估方法的可能性. 方法 对18例经多导睡眠图确诊为OSA的男性飞行人员进行Epwoth嗜睡量表(Epworth sleepiness scale,ESS)评估;行整夜标准多导睡眠监测(polysomnography,PSG),依据呼吸暂停低通气指数(apnea hypopnea index,AHI)区分严重程度,AHI:5～15次/h为轻度,≥15次/h且≤30次/h为中度,＞30次/h为重度;次日行4次40 min MWT.依据医学鉴定结论分为两组,特许飞行合格组和暂时飞行不合格/停飞组.比较两组飞行人员ESS评分、PSG数据和MWT结果差异,并分析MWT平均睡眠潜伏期与ESS评分、PSG数据的相关性. 结果 ①18名飞行人员中,特许飞行合格组8人,暂时飞行不合格/停飞组10人.其中5人为轻度AHI,5人为中度,8人为重度.②暂时飞行不合格/停飞组ESS评分、各项AHI指标、觉醒指数、呼吸相关觉醒指数均高于特许飞行合格组(t=2.308～3.779,P＜0.05);③MWT平均睡眠潜伏期与ESS评分、AHI、快速眼动期AHI、非快速眼动期AHI、仰卧位AHI、觉醒指数、呼吸相关觉醒指数呈负相关(r=-0.635～-0.481,P＜0.05).④暂时飞行不合格/停飞组MWT平均睡眠潜伏期[(10.62士3.91)min]短于特许飞行合格组[(37.80±6.22) min](t=11.333,P＜0.05). 结论 MWT可作为评估OSA飞行人员警觉性的可靠客观检查方法.但基于飞行安全的考虑,仍需进一步研究异常MWT与飞行操作能力的关系.“,”Objective To investigate the possibility of using maintenance of wakefulness test (MWT) as an objective tool in waiver certification for the flying personnel suffering from obstructive sleep apnea (OSA).Methods Epworth sleepiness scale (ESS) was performed in 18 male flying personnel with OSA diagnosed by polysomnography (PSG).Then they were monitored by PSG for one night.The severity of OSA was defined by apnea hypopnea index (AHI) as:mild AHI (5-15 events/h),moderate AHI (≥15 events/h and ≤30 events/h) and severe AHI (＞30 events/h).The 40-min maintenance of wakefulness test (MWT) was conducted for 4 times next day.The flying personnel were grouped by the medical evaluation results as medical waiver group and temporarily/permanently grounded group.ESS score,PSG data and MWT results of flying personnel were compared between different groups.The relationships between MWT mean sleep latency and ESS score,PSG data were also analyzed.Results ①In 18 flying personnel,5 were with mild AHI,5 were with moderate and 8 were with severe.② Medical waiver group had 8 flying personnel while temporarily/permanently grounded group had 10.ESS score,AHI,arousal index and breathing events related arousal index of temporarily/permanently grounded group were significantly higher than those of medical waiver group (t =2.308-3.779,P＜0.05).③Mean sleep latency in MWT showed negative correlation to ESS score,AHI,apnea hypopnea index of rapid eye movement sleep,apnea hypopnea index of non-rapid eye movement sleep,supine apnea hypopnea index,arousal index and breathing events related arousal index (r =-0.635-0.481,P ＜ 0.05).④ The mean sleep latency in MWT of medical waiver group [(10.62 ± 3.91) min] was significantly shorter than that of temporarily/permanently grounded group [(37.80±6.22) min] (t =11.333,P＜0.05).Conclusions MWT is applicable as an objective and reliable tool to evaluate alertness of the flying personnel with OSA.Further studies on finding the correlation between abnormal MWT results and flight operational capacity are still needed for obtaining higher safety reliability.