阻塞性睡眠呼吸暂停综合征对成人哮喘程度的影响

Obstructive sleep apnea syndrome on the severity of adult asthma

目的 评估阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome, OSAS)对成人支气管哮喘(bronchial asthma, BA)程度的影响,分析二者之间的潜在关联性。方法 采用回顾性研究收集2018年1月~2022年6月入江苏省中医院进行治疗的90例BA患者为研究对象,所有患者均接受多导睡眠监测(polysomnography, PSG),以此计算呼吸暂停低通气指数(apnea-hypopnea index, AHI)。依据AHI值将患者分为轻度OSAS(AHI<15)、中度OSAS(15<AHI<30)以及重度OSAS(AHI>30)。此外,测量患者BA相关指标如第一秒用力呼气量(FEV1)、FEV1%、FEV1/用力肺活量(FVC)、呼出气一氧化氮(FeNO)、总气道阻力(R5)、中心气道阻力(R20)以及周边弹性阻力(X5)。采用方差分析比较不同程度OSAS患者BA相关指标差异,Pearson线性相关分析AHI与BA指标测量值的相关性。结果 AHI<15组为1例(1.11%),15<AHI<30为41例(45.56%),AHI>30为48例(53.33%);不同AHI组间性别构成无差异,而70岁及以上年龄段BA患者的AHI取值较高,且年龄别差异具有统计学意义(P<0.05);不同AHI组间结果显示,中重度OSAS患者接受哮喘升级治疗步骤更高,多数位于步骤3和步骤4,差异具有统计学意义(χ^(2)=90.085,P<0.001))。方差结果显示,OSAS越严重,患者的FEV1/FVC(%)比值越低(F=2.600,P=0.011)、FeNO和R5指标越高(F=-6.454;F=-3.291,P<0.001)。Pearson线性相关结果显示,AHI与FEV1%(r=-0.356,P<0.05)、FEV1/FVC(%)(r=-0.289,P<0.001)呈负相关,R5(r=0.447,P<0.05)呈正相关。结论 患有OSAS的BA患者其呼吸功能相关指标明显异常,且随着OSAS的加重,BA也进一步恶化。

Objective To evaluate the effect of obstructive sleep apnea syndrome(OSAS)on the degree of bronchial asthma(BA)in adults,and to analyze the potential relationship between the two.Methods A retrospective study was used to collect 90 patients with BA patients who were admitted to Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2018 to June 2022.All patients received polysomnography(PSG)to calculate the apnea hypopnea index(AHI).Patients were divided into mild OSAS(AHI<15),moderate OSAS(15<AHI<30)and severe OSAS(AHI>30)according to AHI value.In addition,BA related indicators of patients were measured,such as forced expiratory volume in the first second(FEV1),FEV1%,FEV1/forced vital capacity(FVC),exhaled nitric oxide(FeNO),total airway resistance(R5),central airway resistance(R20)and peripheral elastic resistance(X5).Analysis of variance was used to compare the differences in BA related indicators in patients with different degrees of OSAS,and Pearson linear correlation analysis was used to analyze the correlation between AHI and the measured values of BA indicators.Results There was 1 case(1.11%)in AHI<15,41 cases(45.56%)in 15<AHI<30,and 48 cases(53.33%)in AHI>30.There was no difference in gender composition among different AHI groups,but the AHI value of BA patients aged 70 years and above was higher,and the age difference was statistically significant(P<0.05).The results of different AHI groups showed that the patients with moderate to severe OSAS received higher step-up treatment for asthma,most of which were in step 3 and step 4,with a statistically significant difference(2=90.085,P<0.001).The variance analysis results showed that the more severe the OSAS,the lower the ratio of FEV1/FVC(%)(F=2.600,P=0.011),and the higher the FeNO and R5 measurements values(F=-6.454,F=-3.291,P<0.001).Pearson linear correlation analysis showed that AHI was negatively correlated with FEV1%(r=-0.356,P<0.05)and FEV1/FVC%(r=-0.289,P<0.001),but AHI was positively correlated with R5(r=0.447,P<0.05).Conclusion BA patients with OSAS have significantly abnormal respiratory function-related indicators,and with the aggravation of OSAS,BA will further deteriorate.