Department of Neurology, Center for Sleep and Circadian Biology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
COPD. 2009 Dec;6(6):441-5. doi: 10.3109/15412550903433000.
Prior research has shown that individuals with obstructive lung disease are at risk for sleep fragmentation and poor sleep quality. We postulated that patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (known as overlap syndrome) who have more severe lung disease, as measured by lung hyperinflation (inspiratory capacity/total lung capacity), would have greater sleep disturbances independent of traditional measures of sleep apnea. We performed a retrospective chart review of consecutive patients evaluated and treated in an academic pulmonary clinic for overlap syndrome. Pulmonary function tests and polysomnogram data were collected. Thirty patients with overlap syndrome were included in the analysis. We found significant univariable associations between sleep efficiency and apnea/hypopnea index (beta = -0.285, p = 0.01) and between sleep efficiency and lung hyperinflation (beta = 0.654, p = 0.03). Using multivariable linear regression, the relationship between sleep efficiency and lung hyperinflation remained significant (beta = 1.13, p = 0.02) after adjusting for age, sex, body mass index, apnea/hypopnea index, FEV(1)% predicted, oxygen saturation nadir, medications, and cardiac disease. We conclude that increased severity of hyperinflation is associated with worse sleep efficiency, independent of apnea and nocturnal hypoxemia. The mechanisms underlying this observation are uncertain. We speculate that therapies aimed at reducing lung hyperinflation may improve sleep quality in patients with overlap syndrome.
先前的研究表明，阻塞性肺疾病患者存在睡眠碎片化和睡眠质量差的风险。我们推测，慢性阻塞性肺疾病（COPD）和阻塞性睡眠呼吸暂停（称为重叠综合征）患者的肺部疾病更为严重，其测量方法为肺过度充气（吸气量/总肺容量），这些患者的睡眠障碍会更为严重，与睡眠呼吸暂停的传统测量方法无关。我们对在学术肺部诊所中接受重叠综合征评估和治疗的连续患者进行了回顾性图表审查。收集了肺功能测试和多导睡眠图数据。在分析中纳入了 30 名重叠综合征患者。我们发现睡眠效率与呼吸暂停/低通气指数（β=-0.285，p=0.01）和睡眠效率与肺过度充气（β=0.654，p=0.03）之间存在显著的单变量关联。使用多元线性回归，在调整年龄、性别、体重指数、呼吸暂停/低通气指数、FEV1%预计值、氧饱和度最低点、药物和心脏病后，睡眠效率与肺过度充气之间的关系仍然显著（β=1.13，p=0.02）。我们的结论是，肺过度充气的严重程度增加与睡眠效率降低有关，与呼吸暂停和夜间低氧血症无关。这种观察结果的机制尚不确定。我们推测，旨在减少肺过度充气的治疗方法可能会改善重叠综合征患者的睡眠质量。
