慢性阻塞性肺疾病合并阻塞性睡眠呼吸暂停综合征的临床研究

Clinical study of chronic obstructive pulmonary disease complicated with sleep apnea hypopnea syndrome

目的探讨慢性阻塞性肺病(chronic obstructive pulmonarydisease,COPD)合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)亦称重叠综合征(overlap syndrome,OS)患者的临床特点。研究合并OSAHS对于COPD患者病情严重程度的影响。方法对96例稳定期的COPD患者进行多导睡眠监测、静态肺功能、血气分析及超声心动图检测。选择依据PSG结果 ,将COPD患者分为单纯COPD组(n=68)和OS组(n=28)。其中COPD组患者与OS组患者的性别构成比、年龄和体重指数相匹配,差异无统计学意义(P均>0.05)。结果睡眠呼吸紊乱主要指标(AHI、LSaO2、SaO2<90%的时间)两组有显著差异(P<0.01);血气分析两组PaCO2无显著差异,但PaO2在OS组明显低于单纯COPD组。OS患者FEV1占预计值%、FEV1/FVC%与COPD组比较差异有统计学意义。超声心动图测定肺动脉收缩压(PASP),OS组高于COPD组,差异有统计学意义(P>0.05)。单纯COPD患者合并肺动脉高压(PASP≥40mmHg)的患病率为7%(5/68),OS组肺动脉高压患病率为46%(13/28)。结论 OS患者更容易发生肺动脉高压,临床工作中应给予高度关注。

Objective To investigate the clinical charrateristics of chronic obstructive pulmonary disease（COPD） with sleep apnea hypopnea syndrome（os group）,and to examine its impact on the severity of disease among patients with COPD.Methods 96 patients with stable COPD were monitored for one overnight sleep study using polysomnography（PSG）,lung function tests and blood gas analysis.Pulmonary artery pressure levels were measuresd by echocardiogrphy.They were divided into two groups based on their nocturnal apnea hypopnea index（AHI） detected by examination of polysomnography：COPD group（AHI5/h,68 cases） and OS group（AHI≥5/h,28 cases）.Results The sleep-disordered breathing main index（AHI,LSaO2,the time of SaO290%） in two groups had significant difference（P0.01）.The arterial partial pressure of carbon dioxide（PaCO2） were similar（P0.05）;but PaO2 difference between the two groups were statistically significant（P0.01）.The pulmonary artery systolic pressure levels in OS group was significantly higher than that in single COPD group.（P0.05）.The FEV1% of predicted,and FEV1/FVC % in os group were significantly lower than that in the COPD group（P0.05）.The incidence of pulmonary arterial hypertension（PAH）associated with COPD group were 7%（5/68）,in OS group were 46%（13/28）,and there were significantly differences between two groups（P0.05）.Conclusion There has an increased risk of developing pulmonary hypertension in patients with OSAHS and more attention should be paid to OS to avoid missed diagnosis.