Krachman Samuel L, Chatila Wissam, Martin Ubaldo J, Nugent Thomas, Crocetti Joseph, Gaughan John, Criner Gerard J
Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
Chest. 2005 Nov;128(5):3221-8. doi: 10.1378/chest.128.5.3221.
We hypothesized that associated with improvements in respiratory mechanics, lung volume reduction surgery (LVRS) would result in an improvement in both sleep quality and nocturnal oxygenation in patients with severe emphysema.
Prospective randomized controlled trial.
University hospital.
Sixteen patients (10 men, 63 +/- 6 years [+/- SD]) with severe airflow limitation (FEV(1), 28 +/- 10% predicted) and hyperinflation (total lung capacity, 123 +/- 14% predicted) who were part of the National Emphysema Treatment Trial.
Patients completed 6 to 10 weeks of outpatient pulmonary rehabilitation. Spirometry, measurement of lung volumes, arterial blood gas analysis, and polysomnography were performed prior to randomization and again 6 months after therapy. Ten patients underwent LVRS and optimal medical therapy, while 6 patients received optimal medical therapy only.
Total sleep time and sleep efficiency improved following LVRS (from 184 +/- 111 to 272 +/- 126 min [p = 0.007], and from 45 +/- 26 to 61 +/- 26% [p = 0.01], respectively), while there was no change with medical therapy alone (236 +/- 75 to 211 +/- 125 min [p = 0.8], and from 60 +/- 18 to 52 +/- 17% [p = 0.5], respectively). The mean and lowest oxygen saturation during the night improved with LVRS (from 90 +/- 7 to 93 +/- 4% [p = 0.05], and from 83 +/- 10 to 86 +/- 10% [p = 0.03], respectively), while no change was noted in the medical therapy group (from 91 +/- 5 to 91 +/- 5 [p = 1.0], and from 84 +/- 5 to 82 +/- 6% [p = 0.3], respectively). There was a correlation between the change in FEV(1) and change in the lowest oxygen saturation during the night (r = 0.6, p = 0.02). In addition, there was an inverse correlation between the change in the lowest oxygen saturation during the night and the change in residual volume (- r = 0.5, p = 0.04) and functional residual capacity (- r = 0.6, p = 0.03).
In patients with severe emphysema, LVRS, but not continued optimal medical therapy, results in improved sleep quality and nocturnal oxygenation. Improvements in nocturnal oxygenation correlate with improved airflow and a decrease in hyperinflation and air trapping.
我们假设，与呼吸力学改善相关的肺减容手术（LVRS）将使重度肺气肿患者的睡眠质量和夜间氧合均得到改善。
前瞻性随机对照试验。
大学医院。
16例患者（10名男性，63±6岁[±标准差]），属于国家肺气肿治疗试验的一部分，患有严重气流受限（FEV₁，预计值的28±10%）和肺过度充气（肺总量，预计值的123±14%）。
患者完成6至10周的门诊肺康复治疗。在随机分组前及治疗6个月后分别进行肺量计检查、肺容积测量、动脉血气分析和多导睡眠图检查。10例患者接受LVRS及最佳药物治疗，而6例患者仅接受最佳药物治疗。
LVRS后总睡眠时间和睡眠效率有所改善（分别从184±111分钟增至272±126分钟[p = 0.007]，以及从45±26%增至61±26%[p = 0.01]），而单纯药物治疗无变化（分别从236±75分钟降至211±125分钟[p = 0.8]，以及从60±18%降至52±17%[p = 0.5]）。夜间平均及最低氧饱和度在LVRS后有所改善（分别从90±7%增至93±4%[p = 0.05]，以及从83±10%增至86±10%[p = 0.03]），而药物治疗组无变化（分别从91±5%降至91±5%[p = 1.0]，以及从84±5%降至82±6%[p = 0.3]）。FEV₁的变化与夜间最低氧饱和度的变化之间存在相关性（r = 0.6，p = 0.02）。此外，夜间最低氧饱和度的变化与残气量的变化呈负相关（-r = 0.5，p = 0.04）以及与功能残气量的变化呈负相关（-r = 0.6，p = 0.03）。
在重度肺气肿患者中，LVRS而非持续的最佳药物治疗可改善睡眠质量和夜间氧合。夜间氧合的改善与气流改善以及肺过度充气和气体潴留的减少相关。
