阻塞性睡眠呼吸暂停综合征合并肺气肿表型为主慢阻肺的临床特征分析

Analysis of clinical characteristics of obstructive sleep apnea hypopnea syndrome complicated and chronic obstructive pulmonary disease with the emphysematous phenotype

目的:研究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)合并肺气肿表型为主的慢性阻塞性肺疾病[以下简称慢阻肺(chronic obstructive pulmonary disease,COPD)]即COPD-OSAHS重叠综合征的临床特征和影响因素,为临床实践提供认识和指导。方法:采用病例对照研究,纳入2015年3月至2022年6月昆明医科大学第二附属医院收治的301例OSAHS患者。依据分型标准对COPD-OSAHS重叠综合征组进行影像学表型分型分为肺气肿表型为主和非肺气肿表型为主2组。分别比较3组患者的人口学资料、肺功能、夜间多导睡眠监测指标、胸部影像学指标、合并症等临床特征,采用偏相关分析和logistic回归分析OSAHS合并肺气肿表型为主慢阻肺发病的影响因素。结果:肺气肿表型为主COPD合并OSAHS组与单纯OSAHS患者和非肺气肿表型为主COPD-OSAHS重叠综合征患者相比,性别、吸烟情况、呼吸困难、体质指数(body mass index,BMI)、呼吸暂停低通气指数(apnea hypopnea index,AHI)、双肺渗出容积百分比、双肺塌陷容积百分比存在统计学意义(均P<0.05)。非肺气肿表型为主较肺气肿为主型COPD-OSAHS重叠综合征组患者相比肺动脉压、夜间脉氧饱和度<85%的时间(saturation of pulse oxygen less than 85%of the time,TS85)、氧减指数(oxygen desaturation index,ODI)差异均有统计学意义(均P<0.05),合并肺心病、房颤、下肢浮肿发生率高。相关性分析结果显示BMI、吸烟指数、AHI、TS85、ODI、双肺渗出容积百分比、双肺塌陷容积百分比、两肺低于-950 HU的低密度衰减区(low attenuation area,LAA)与双肺体积的占比(LAA%)均呈负相关(r=-0.434、-0.254、-0.439、-0.327、-0.336、-0.756、-0.609),均具有统计学意义(均P<0.05);肺气肿表型为主的COPD合并OSAHS患者相关因素二元logistic回归分析中,BMI(OR=0.891,95%CI=0.807~0.984)、AHI(OR=0.948,95%CI=0.918~0.979)、双肺塌陷容积百分比(OR=0.406,95%CI=0.265~0.623)为主要影响因素(均P<0.05)。结论:肺气肿表型为主COPD-OSAHS重叠综合征较非肺气肿型COPD-OSAHS重叠综合征和单纯OSAHS患者相比,男性占比大、吸烟更多,呼吸困难更明显,BMI、AHI指数较低,双肺内塌陷占比较少,其中非肺气肿型COPD-OSAHS重叠综合征患者肺动脉压更高,咳嗽、咳痰更明显,合并肺心病、房颤、下肢浮肿较多,缺氧时间更长。其中BMI、AHI、双肺塌陷容积百分比为肺气肿表型为主的COPD合并OSAHS患者主要影响因素。

Objective:To study the clinical characteristics and influencing factors of obstructive sleep apnea hypopnea syndrome(OSAHS)and chronic obstructive pulmonary disease(COPD)with the emphysematous phenotype,namely COPD-OSAHS overlap syn⁃drome,so as to provide understanding and guidance for clinical practice.Methods:A retrospective case-control study was conducted on 301 patients with OSAHS admitted to The Second Affiliated Hospital of Kunming Medical University from March 2015 to June 2022.The COPD-OSAHS overlap syndrome group was divided into two groups:COPD patients with the emphysematous phenotype and non-emphysematous phenotype according to Goddard's classification criteria.The demographic data,pulmonary function,night poly⁃somnography monitoring indexes,chest imaging parameters,compli⁃cations,and other characteristics were compared separately.Partial correlation analysis and logistic regression were used to analyze the influencing factors of OSAHS with COPD with the emphysematous phenotype.Results:There were statistically significant differences in sex,smoking,dyspnea,BMI,apnea hypopnea index(AHI),Infiltrated%and Collapsed%in the COPD-OSAHS overlap syndrome with emphysematous phenotype patients compared with the simple OSAHS group and non-emphysematous phenotype group(all P<0.05).And pulmonary artery pressure,TS85 and oxygen desaturation in⁃dex(ODI)between COPD-OSAHS overlap syndrome patients with emphysematous phenotype and non-emphysematous phenotype were statistically significant(all P<0.05).The incidence of pulmonary heart disease,atrial fibrillation and lower limb edema was higher in COPD-OSAHS overlap syndrome patients with non-emphysematous phenotype group.The results of correlation analysis showed that BMI,smoking index,AHI,TS85,ODI,Infiltrated%,Collapsed%were negatively correlated with LAA%(r=-0.434,-0.254,-0.439,-0.327,-0.336,-0.756,-0.609),with statistical significance(all P<0.05).In the logistic regression analysis of the related fac⁃tors of COPD patients with emphysematous phenotype and OSAHS patients,BMI(OR=0.891,95%CI=0.807-0.984),AHI(OR=0.948,95%CI=0.918-0.979),Collapsed%(OR=0.406,95%CI=0.265-0.623)were the main influencing factors(all P<0.05).Conclusion:Compared with the simple OSAHS group and non-emphysematous phenotype group,COPD-OSAHS overlap syndrome with emphyse⁃matous phenotype patients have a larger proportion of males,smoking,dyspnea,lower index of BMI and AHI,less collapse%in both lungs,and higher pulmonary artery pressure,more cough and expectoration,more complicated with pulmonary heart disease,atrial fi⁃brillation,lower limb edema and longer hypoxia time in COPD-OSAHS overlap syndrome with non-emphysematous phenotype com⁃pared with simple OSAHS.And BMI,AHI and Collapsed%are the main influencing factors in patients with COPD with the emphyse⁃matous phenotype and OSAHS.