重叠综合征患者睡眠呼吸紊乱特征及持续气道正压通气对嗜睡、疲劳、焦虑抑郁的影响

Characteristics of Sleep-Disordered Breathing in Patients with Overlap Syndrome and the Effects of Continuous Positive Airway Pressure(CPAP) on Sleepiness, Fatigue, Anxiety and Depression

目的 探讨慢性阻塞性肺病(COPD)-阻塞性睡眠呼吸暂停(OSA)重叠综合征患者(OS)夜间睡眠呼吸紊乱特征及持续气道正压通气(CPAP)对嗜睡、疲劳、焦虑抑郁的影响。方法 选取2016年2月—2017年4月在郑州大学第一附属医院呼吸睡眠科就诊的OSA和OS患者共68例。根据多导睡眠图(PSG)监测和肺功能将其分为OS组(34例)和OSA组(34例),并纳入30例单纯鼾症者作对照组。给予OS组和OSA组CPAP治疗3个月,比较治疗前、后两组嗜睡量表(ESS),疲劳严重程度量表(FSS)和住院焦虑和抑郁量表(HADS)评分。结果 OS患者总睡眠时间(TST)、入睡后觉醒时间(WASO)、睡眠效率、非快速眼动期1期(NREM1%)、睡眠快速眼动期(REM)%和微觉醒指数分别是[(248±46)min,(89±50)min,(74±11)%,(66.1±20.8)%,(8.1±5.1)%,(38±12)次/h],均明显差于OSA组和对照组上述指标水平[(273±51)min,(310±60)min;(82±9)%,(90±6)%;(41.6±19.3)%,(10.3±2.8)%;(14.8±4.4)%,(19.7±4.5)%;(27±14)次/h,(4.2±1.9)次/h](P<0.05)。OS组患者夜间睡眠呼吸暂停低通气指数(AHI)、血氧饱和度<90%的时间占总睡眠时间比例(TST90)和氧减指数分别是[(31.4±11.2)次/h,(32.2±8.6)%,(34.8±7.5)次/h]均显著高于OSA组和对照组水平[(28.2±10.7)次/h,(3.6±2.0)次/h;(27.4±10.4)%,(1.7±2.6)%;(24.7±6.9)次/h,(1.4±2.5)次/h](P<0.05)。OS组患者夜间最低血氧饱和度(LowSpO2)(52±7)%显著低于OSA组和对照组[(68±8)%,(85±5)%](P<0.05)。OS组CPAP治疗后嗜睡(ESS),疲劳(FSS)评分分别[(6.7±1.8)分、(3.66±1.84)分]显著低于治疗前[(14.6±4.2)分、(5.91±1.73)分]及OSA组[(11.4±5.3)分、(4.17±2.12)分](P<0.05);OS组治疗后焦虑和抑郁评分对比治疗前和OSA组差异无统计学意义(P>0.05)。结论 OS患者睡眠结构紊乱更重,睡眠呼吸暂停事件更严重;日间嗜睡、疲劳、焦虑抑郁的比例更高;CPAP治疗有助于改善嗜睡、和疲劳,但焦虑和抑郁改善有限。

Objective To investigate the characteristics of nocturnal sleep-disordered breathing in patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) overlap syndrome and the effects of continuous positive airway pressure (CPAP) on sleepiness, fatigue, anxiety and depression. Methods A total of 68 patients with OSA or OS who were admitted to the Department of Respiratory Sleeping, the First Affiliated Hospital of Zhengzhou University from February 2016 to April 2017 were enrolled. According to polysomnography (PSG) monitoring and pulmonary function, they were divided into OS group (34 cases) and OSA group (34 cases). And 30 cases of simple snoring were included as control group. Patients in the OS group and the OSA group were treated with CPAP for 3 months, and the pre- and post-treatment sleepiness scale (ESS), fatigue severity scale (FSS), and hospitalization anxiety and depression scale (HADS) scores were compared between the two groups. Results In the OS group, the total sleep time (TST), wakefulness after sleep (WASO), sleep efficiency, non-rapid eye movement phase 1 (NREM1%), sleep rapid eye movement (REM)%, and arousal index were [(248±46)min,(89±50)min,(74±11)%,(66.1±20.8)%,(8.1±5.1)%,(38±12) times/h], were significantly worse than those of the OSA group and control group [(273±51) min,(310±60) min;(65±54) min,(48±47) min;(82±9)%,(90±6)%;(41.6±19.3)%,(10.3±2.8)%;(14.8±4.4)%,(19.7±4.5)%;(27±14) times/h,(4.2±1.9) times/h](P<0.05). The sleep apnea hypopnea index (AHI), the oxygen saturation rate <90% of the OS group, the total sleep time ratio (TST90) and the oxygen reduction index were [(31.4±11.2) times/h,(32.2±8.6)%,(34.8±7.5) times/h], which were significantly higher than those of the OSA group and control group [(28.2±10.7) times/h,(3.6±2.0) times/h;(27.4±10.4)%,(1.7±2.6)%;(24.7±6.9) times/h,(1.4±2.5) times/h](P<0.05). The minimum oxygen saturation (LowSpO2)(52±7)% in the OS group was significantly lower than that in the OSA group and the control group [(68±8)%,(85±5)%](P<0.05). The sleepiness (ESS) and fatigue (FSS) scores in the OS group after CPAP treatment [(6.7±1.8) points,(3.66±1.84) points] were significantly lower than those before the treatment [(14.6±4.2) points,(5.91±1.73) points] and those in the OSA group [(11.4±5.3) points,(4.17±2.12) points](P<0.05). There was no difference in anxiety and depression scores between OS group and OSA group before treatment (P>0.05). Conclusion OS patients have more severe sleep disorder and more severe sleep apnea events. The proportion of daytime sleepiness, fatigue, anxiety and depression is higher. CPAP treatment can improve sleepiness and fatigue, but the improvement in anxiety and depression are limited.