稳定期慢性阻塞性肺疾病患者夜间睡眠特点及长效抗胆碱能药物治疗的影响

Nighttime sleep characteristics of stable chronic obstructive pulmonary disease patients and the influence of longacting muscarinic antagonist treatment

目的：研究稳定期慢性阻塞性肺疾病（COPD）患者夜间睡眠的特点以及噻托溴铵粉吸入剂治疗对COPD患者肺功能及夜间睡眠的影响。方法：入选2010年9月至2011年8月18例中到重度肺功能受损的COPD患者,基线肺功能检查第1秒用力呼气容积（FEV1）在预计值参考范围的30%~80%,且支气管舒张实验阴性。其中男17例,女1例,年龄54~78（65.7±6.6）岁,平均体质量指数（BMI）为24.1±2.5（19.6~27.3）。入组后予以患者吸入皮质激素（ICS）单药洗脱2周后,予正规的ICS＋长效抗胆碱支气管扩张剂（LAMA）治疗3个月。在基线期和3个月后分别进行肺功能及全夜多导睡眠图（PSG）检测。结果：稳定期无需氧疗的中重度肺功能损害COPD患者夜间低氧并不显著[呼吸紊乱指数（RDI）7.1±7.5,最低指脉搏氧饱和度（SpO2）83.9%±8.4%、SpO2低于90%的时间（7.4±12.2）min、平均SpO294.2%±2.4%],且与基础肺功能相关性不大,RDI主要仍与患者BMI相关（r=0.3,P=0.02）,但睡眠期存在明显的微觉醒时间（平均微觉醒指数27.1±16.0）。经短期治疗前后肺功能[FEV1、用力肺活量（FVC）、残气量/肺总量比（RV/TLC）]及夜间睡眠低氧状况（夜间睡眠期RDI、最低SpO2、SpO2低于90%的时间、平均SpO2）变化不明显。但其中患者治疗后微觉醒指数明显下降（27.1±16.0比17.1±13.4,P=0.01）。结论：中重度肺功能损害的稳定期COPD患者夜间存在以微觉醒增多为特征的睡眠紊乱,LAMA治疗能提高COPD患者夜间睡眠质量;短期治疗对肺功能影响不大。

Objective To analyze the characteristics of nighttime sleep in stable chronic obstructive pulmonary disease （COPD） patients and the effect of long-acting muscarinic antagonist （LAMA）therapy on lung function and nocturnal sleep. Methods A total of 18 stable COPD patients with mild to moderate impairment of lung function were enrolled, baseline forced expiratory volume in one second （FEVI） was 30%-80% of predicted value, and bronchial dilation test was negative. Seventeen were male and 1 was female , with a mean age of （65.7±6.6） years and a mean body mass index （BMI） of 24.1±2.5 . All patients underwent a wash up for 2 weeks by inhalating corticoid steroid （ICS） alone after being included in the test, lung function test and full-night polysomnogram （PSG） were performed at baseline and after 3 months regular treatment of ICS＋LAMA. Results Stable COPD patients with mild to moderate pulmonary function impairment did not show significant hypoxia during nighttime sleep, mean respiratory distress index （RDI） was 7.1±7.5, mean lowest pulse oxygen saturation （the lowest SpO2） was 83.9%±8.4%, time of SpO2 below 90% （TS90） was （7.4±12.2） min, mean pulse oxygen saturation （MSpO2） was 94.2%±2.4%, with no obvious correlation with baseline lung function, but correlated with BMI （r=0.3）. The patients had a decreased sleep quality with an arousal index of 27.1± 16.0. Short term treatment of ICS＋LAMA failed to demonstrate significant influence on lung function and nocturnal sleep hypoxia, but the arousal index decreased significantly after 3 months therapy （17.1 vs 27.1, P=0.001）. ConclusionsStable COPD patients with mild to moderate impairment of lung function presented a sleep disorder characterized by increased arousal. LAMA treatment could improve the sleep quality of patients with COPD, but short term LAMA therapy had no significant influence on lung function.