持续气道正压通气依从性对慢阻肺-阻塞性睡眠呼吸暂停重叠综合征患者肺功能和急性加重的影响

Effect of continuous positive airway pressure ventilation compliance on lung function and acute exacerbation in patients with COPD-OSA overlap syndrome

目的观察持续气道正压通气(CPAP)依从性对阻塞性睡眠呼吸暂停(OSA)和慢性阻塞性肺疾病(简称慢阻肺)重叠综合征(OS)患者肺功能和急性加重的影响。方法选取2021年2月至2023年2月的OS患者80例,向其宣教良好遵守CPAP和日常正确使用装置的说明,≥70%的夜晚平均每晚使用CPAP≥4h者40例定义为依从性良好,纳入观察组,其余40例纳入对照组。比较两组治疗前后肺功能、血气参数、慢阻肺相关症状和急性加重情况。结果中位CPAP治疗时间观察组为5.5(4.6,6.7)h/夜,对照组为0.6(0,3.3)h/夜。治疗后观察组PaO 2、FEV 1预测值%、FVC预测值%、TLC预测值%、6MWT均高于治疗前及对照组治疗后,PaCO 2和HCO-3、RV/TLC、CAT和mMRC均低于治疗前及对照组治疗后。观察组治疗后12个月内急性加重和加重入院次数较前降低,且低于对照组治疗后。CPAP使用时间与慢阻肺加重次数呈负相关(r=-0.259,P=0.047)。CPAP依从性差的患者比依从性好的患者更易发生慢阻肺急性加重(β=0.362,95%CI:0.075~0.649,P=0.015)。结论CPAP依从性好的OS患者治疗期间慢阻肺急性加重次数较前减少,肺功能和慢阻肺相关症状有所改善。

Objective To observe the effect of continuous positive airway pressure(CPAP)adherence on pulmonary function and acute exacerbation in patients with obstructive sleep apnea(OSA)and chronic obstructive pulmonary disease(COPD)overlap syndrome(OS).Methods A total of 80 patients with OS were selected from February 2021 to February 2023,and the instructions for good compliance with CPAP and correct daily use of the device were taught to them.40 patients who used CPAP for an average of≥70%of nights for≥4h per night were defined as good compliance and included in the observation group,while the other 40 patients were included in the control group.Lung function,blood gas parameters,functional ability and acute exacerbation were compared between the two groups before and after treatment.Results The median duration of CPAP treatment was 5.5(4.6,6.7)h/night in the observation group and 0.6(0,3.3)h/night in the control group.After treatment,PaO 2,FEV 1 predictive value%,FVC predictive value%,TLC predictive value%,and 6MWT in the observation group were higher than before treatment and after treatment in the control group,PaCO 2,HCO-3,RV/TLC,CAT and mMRC were lower than before treatment and after treatment in the control group.In the observation group,the number of acute exacerbation and acute hospitalization in 12 months after treatment was lower than that in the control group.The duration of CPAP use was negatively correlated with COPD exacerbation(r=-0.259,P=0.047).Patients with poor CPAP compliance had more exacerbation than those with good compliance(β=0.362,95%CI:0.075-0.649,P=0.015).Conclusion The number of AECOPD in OS patients with good CPAP compliance decreases during 12 months of treatment,and lung function and COPD related symptoms improve.