慢性阻塞性肺疾病患者合并OSAHS对高碳酸血症的影响及其相关因素

Effects of chronic obstructive pulmonary disease patients complicated with OSAHS on hypercapnia and related factors

目的分析慢性阻塞性肺疾病(简称慢阻肺)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对高碳酸血症的影响及其相关因素。方法本研究为横断面研究,连续招募2016年7月至2018年12月就诊于北京大学第三医院呼吸科门诊的稳定期慢阻肺患者,收集患者的一般临床资料,完善肺功能、动脉血气分析和家庭便携式睡眠监测。将慢阻肺患者合并呼吸暂停低通气指数(AHI)≥10次/h,呼吸暂停事件以阻塞型事件为主,伴打鼾、睡眠呼吸暂停、日间嗜睡等症状定义为合并OSAHS组,慢阻肺患者合并AHI<10次/h定义为单纯慢阻肺组。通过相关分析和logistic回归模型探索慢阻肺患者高碳酸血症的影响及其相关因素。结果合并OSAHS组动脉血二氧化碳分压(PaCO_(2))中位值和日间高碳酸血症比例均显著高于单纯慢阻肺组[42.00比38.95 mmHg(1 mmHg=0.133 kPa),P<0.001和23.3%比3.3%,P=0.002]。PaCO_(2)与用力肺活量(FVC)、第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1%预计值)、残气量/肺总量(RV/TLC)、AHI、夜间平均脉搏血氧饱和度(SpO2)、夜间最低SpO2、夜间SpO2≤90%的睡眠时间占比(T90)存在不同程度的相关性(均P<0.05)。在logistic回归分析中,调整年龄、性别、体重指数因素后,只有重度OSAHS、GOLDⅢ~Ⅳ级(FEV1%预计值<50%)和T90>1%是高碳酸血症的独立危险因素。结论OSAHS可增加慢阻肺患者高碳酸血症的风险,AHI、肺功能损伤和T90与高碳酸血症的发生密切相关。

Objective To analyze the effects of chronic obstructive pulmonary disease(COPD)combined with obstructive sleep apnea hypopnea syndrome(OSAHS)on hypercapnia and its related factors.Methods In this cross-sectional study,patients with stable COPD were continuously recruited from July 2016 to December 2018 in the Respiratory Department of Peking University Third Hospital.General clinical data of patients were collected,and lung function test,arterial blood gas analysis and portable sleep monitoring were also conducted.Patients with COPD complicated with apnea hypopnea index(AHI)≥10 times/h and apnea events being mainly blockage-type events,accompanied by snoring,sleep apnea,daytime sleepiness and other symptoms were defined as overlapping group,patients with COPD complicated with AHI<10 times/h were defined as simple COPD group.Correlation analysis and logistic regression model were used to explore the determinants of daytime hypercapnia in patients with COPD.Results Compared with simple COPD group,the median arterial partial pressure of carbon dioxide(PaCO2)was significantly higher in the overlapping group(42.00 vs 38.95 mmHg(1 mmHg=0.133 kPa),P<0.001),and the rate of daytime hypercapnia was significantly higher(23.3%vs 3.3%,P=0.002).PaCO2 was correlated with forced vital capacity(FVC),percent predicted forced expiratory volume in one second(FEV1%pred),the ratio of residual volume(RV)to total lung capacity(TLC),AHI,nocturnal average transcutaneous oxygen saturation(SpO2),nocturnal minimum SpO2 and the total sleep time spent with SpO2≤90%(T90)(all P<0.05).In logistic regression analysis,after adjusting for age,sex,and body mass index(BMI),only severe OSAHS,GOLDⅢ-Ⅳgrade(FEV1%pred<50%),and T90>1%were independent risk factors for hypercapnia.Conclusions OSAHS can increase the risk of hypercapnia in patients with COPD.AHI,lung function injury and T90 are closely related to hypercapnia.