阻塞性睡眠呼吸暂停低通气综合征合并慢性阻塞性肺疾病的重叠综合征临床特点

Analysis of clinical characteristics of chronic obstructive pulmonary disease-obstructive sleep apnea-hypopnea syndrome overlap syndrome

目的 探讨重叠综合征（OS）患者的临床特征,为OS的诊断和治疗提供参考.方法 选取96例阻塞性睡眠呼吸暂停低通气综合征（OSAHS）、36例慢性阻塞性肺疾病（COPD）、32例OS患者以及13例正常对照者,询问其Epworth嗜睡评分（ESS）、高血压病史,测定其颈围,计算BMI,所有患者均行多导睡眠监测、肺功能和动脉血气测定,记录呼吸暂停低通气指数（AHI）、最长呼吸暂停时间（LAT）、夜间最低氧饱和度（LSaO2）、夜间平均氧饱和度（MSaO2）、血氧饱和度＜90％时间占监测总时间的百分比（Ts90％）、慢波睡眠（Ⅲ期睡眠）及快速眼动相睡眠（REM）占总睡眠百分比、微觉醒指数、夜间心律失常发生率,第一秒用力呼气容积（FEV1）占预计值百分比、FEV1/用力肺活量（FVC）、PaO2和PaCO2等指标,并对相应结果进行统计分析.结果 OS组和OSAHS组患者的BMI、颈围显著高于COPD组和对照组.OS组患者ESS、AHI、PaCO2等数值明显高于COPD组、OSAHS组和对照组,而夜间最低血氧饱和度、平均氧饱和度、FEV1％和FEV1/FVC等则明显低于其他3组（P＜0.05）.结论 OSAHS伴有肥胖者COPD患者更易患OS.OS患者夜间低氧血症、睡眠质量、肺功能减退程度以及日间低氧血症和高碳酸血症较单纯COPD或OSAHS更严重.应提高对OS的认识.

Objective To study the clinical characteristics of chron^ic0bstructive pulmonary dis- ease（ COPD）- obstructive sleep apnea-hypopnea syndrome （OSAHS） overlap syndrome （OS）. SO as to provide a reference for the diagnosis of OS. Methods 96 patients as OSAHS,36 patients diagnosed as COPD,32 patients as OS and 13 people as normal control were enrolled. Body mass index（BMI）, neck circumference （ NC）, Epwonh sleepiness scale （ ESS）, apnea hypopnea index （ AHI ）, Ts90%, the longest apnea time （ LAT）, mean oxygen saturation （ MSaO2 ） , lowest oxygen saturation （ LSaO2 ）, forced expiratory volume in one second（ FEV1 ）, FEV1/forced vital capality （FVC）, PaO2, PaCO2 were measured and ana- lyzed. Results BMI, NC, AHI, and ESS of OS patients were significantly higher than those in the other three groups,while the LSaO2, MSaO2, FEV~ and FEV1/FVC in OS group were significantly lower than those in the other three groups （ P 〈 0.05）. Conclusions Patients as OS experienced more severe condi- tions, and more attention should be paid to OS to avoid missed diagnosis.