稳定期慢性阻塞性肺病患者睡眠呼吸障碍临床分析

Clinical investigation of sleep apnea disorder in stable phase COPD patients

目的:分析稳定期慢性阻塞性肺病(COPD)合并睡眠呼吸暂停低通气综合征(SAHS)即重叠综合征(OS)患者睡眠呼吸紊乱的发病情况及临床特点,从睡眠医学角度提高对COPD本质及临床特点的认识。方法:对124例稳定期COPD患者在不吸氧情况下进行夜间睡眠呼吸监测,以其中睡眠呼吸暂停低通气指数(AHI)≥10次/h诊断为SAHS,选择年龄、性别及体质指数与其相匹配的64例单纯COPD患者(单纯COPD组),对比分析其睡眠呼吸紊乱的特点。结果:124例COPD患者中,OS患者占27.4%(34/124);OS组与单纯COPD组患者相比,AHI、睡眠呼吸紊乱类型、低通气指数(HI)占AHI百分比及脉氧饱和度SpO2<90%、85%、80%的时间占总睡眠时间百分数(SIT90%,SIT85%,SIT80%)等指标均有明显差异。结论:推测目前在我国稳定期COPD患者中OS发生率为25%～30%;与单纯COPD患者相比,OS组睡眠呼吸紊乱更严重,其类型以低通气为主;OS患者较单纯COPD患者存在有更严重低氧血症;SIT90%、SIT85%及最低SpO2是反映OS患者睡眠期低氧血症的最敏感指标。

Objective：To investigate the outsets and manifestation of sleep disorders in stable phase of COPD patients combind with SAHS （Sleep Apnea/Hypoventilation Syndrome） ,so as to improve the understanding of origin and clinical features of COPD from the aspect of sleep medicine. Methods： 124 stable phase COPD patients were subjected to continuous blood oxygen saturation measurement during the sleep without any oxygenation. Multi-lead polygraph examination was performed to obtain ODI and AHI （ODI〉5 incidents per hour or AHI ≥ 10 incidents per hour as a diagnostic standard for SAHS）. 64 COPD patients without any complications were selected as control. These controls were paired with the above COPD patients who were complicated with SAHS, according to their age, gender and WI （Weight Index）. The features of sleep disorders were analyzed by comparing the individuals in the paired groups. Results：27.4% of the 124 patients with COPD （34/124） had overlapping syndrome （COPD ＋ SAHS）. Statistically significant differences were found between the two groups among AHI, pattern of sleep disorder, ODI/AHI % and SIT90%, SIT85%, SIT80% （the percentage of sleep time when SpO2〈90%, 85%, 80% to the total sleep time）. Conclusion：It was estimated that there were about 25%-30% of stable COPD patients with overlapping syndrome presently in our country. Comparing with the uncomplicated COPD patients, the OS had severe sleep disorder pattern, predominantly the hypoventilation types. The OS had more severe hypoxemia. SIT90%, SIT85% and LSpO2 were the most sensitive indexes for hypoxemia in OS patients during the sleep.