社区肺科门诊中的慢性咳嗽与阻塞性睡眠呼吸暂停
Chronic cough and obstructive sleep apnea in a community-based pulmonary practice.
作者信息
Sundar Krishna M, Daly Sarah E, Pearce Michael J, Alward William T
机构信息
Intermountain Utah Valley Pulmonary Clinic, 1055N, 300W, Provo, UT 84604, USA.
出版信息
Cough. 2010 Apr 15;6(1):2. doi: 10.1186/1745-9974-6-2.
BACKGROUND
Recent reports suggest an association between unexplained chronic cough and obstructive sleep apnea (OSA). Current guidelines provide an empiric integrative approach to the management of chronic cough, particularly for etiologies of gastroesophageal reflux (GERD), upper airway cough syndrome (UACS) and cough variant asthma (CVA) but do not provide any recommendations regarding testing for OSA. This study was done to evaluate the prevalence of OSA in patients referred for chronic cough and examine the impact of treating OSA in resolution of chronic cough.
METHODS
A retrospective review of chronic cough patients seen over a four-year period in a community-based pulmonary practice was done. Patients with abnormal chest radiographs, abnormal pulmonary function tests, history of known parenchymal lung disease, and inadequate followup were excluded. Clinical data, treatments provided and degree of resolution of cough was evaluated based on chart review. Specifically, diagnostic testing for OSA and impact of management of OSA on chronic cough was assessed.
RESULTS
75 patients with isolated chronic cough were identified. 44/75 had single etiologies for cough (GERD 37%, UACS 12%, CVA 8%). 31/75 had multiple etiologies for their chronic cough (GERD-UACS 31%, GERD-CVA 5%, UACS-CVA 3%, GERD-UACS-CVA 3%). 31% patients underwent further diagnostic testing to evaluate for UACS, GERD and CVA. Specific testing for OSA was carried out in 38/75 (51%) patients and 33/75 (44%) were found to have obstructive sleep apnea. 93% of the patients that had interventions to optimize their sleep-disordered breathing had improvement in their cough.
CONCLUSIONS
OSA is a common finding in patients with chronic cough, even when another cause of cough has been identified. CPAP therapy in combination with other specific therapy for cough leads to a reduction in cough severity. Sleep apnea evaluation and therapy needs to considered early during the management of chronic cough and as a part of the diagnostic workup for chronic cough.
背景
近期报告显示不明原因的慢性咳嗽与阻塞性睡眠呼吸暂停（OSA）之间存在关联。当前指南提供了一种经验性的综合方法来管理慢性咳嗽，特别是针对胃食管反流（GERD）、上气道咳嗽综合征（UACS）和咳嗽变异性哮喘（CVA）的病因，但未提供关于OSA检测的任何建议。本研究旨在评估因慢性咳嗽转诊患者中OSA的患病率，并探讨治疗OSA对慢性咳嗽缓解的影响。
方法
对一家社区肺科诊所四年期间诊治的慢性咳嗽患者进行回顾性研究。排除胸部X光片异常、肺功能测试异常、已知实质性肺病病史以及随访不充分的患者。通过病历审查评估临床数据、所提供的治疗以及咳嗽缓解程度。具体而言，评估OSA的诊断测试以及OSA管理对慢性咳嗽的影响。
结果
确定了75例单纯慢性咳嗽患者。44/75例患者咳嗽有单一病因（GERD占37%，UACS占12%，CVA占8%）。31/75例患者慢性咳嗽有多种病因（GERD-UACS占31%，GERD-CVA占5%，UACS-CVA占3%，GERD-UACS-CVA占3%）。31%的患者接受了进一步的诊断测试以评估UACS、GERD和CVA。38/75（51%）例患者进行了OSA的特异性检测，其中33/75（44%）例被发现患有阻塞性睡眠呼吸暂停。93%接受干预以优化睡眠呼吸紊乱的患者咳嗽症状有所改善。
结论
OSA在慢性咳嗽患者中很常见，即使已确定咳嗽的其他原因。持续气道正压通气（CPAP）治疗联合其他针对咳嗽的特异性治疗可减轻咳嗽严重程度。在慢性咳嗽管理早期以及作为慢性咳嗽诊断检查的一部分，需要考虑睡眠呼吸暂停的评估和治疗。
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