Department of Cardiology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Respir Med. 2012 Sep;106(9):1335-41. doi: 10.1016/j.rmed.2012.05.006. Epub 2012 Jun 16.
The chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have been recently much focused as independent risks for cardiovascular disease. Furthermore, the complication of both has a worse prognosis compared with patients with only one of these diseases. However, the details of the underlying mechanisms of this worsened prognosis have not been clear. The cross-sectional study was conducted to examine whether the overlap of COPD augment the increase in arterial stiffness in subjects with OSA. If so, we examined the exaggeration of nocturnal hypoxemia and its related inflammation are related to this augmentation of increased arterial stiffness. In 524 male subjects with OSA diagnosed by polysomnography (apnea-hypopnea index >5/h) (52 ± 14 years old), the forced expiratory volume at 1 s/the forced vital capacity (FEV(1)/FVC) ratio, brachial-ankle pulse wave velocity (baPWV), blood C-reactive protein (CRP) and B-natriuretic peptide (BNP) levels were measured. The prevalence rate of COPD was 12% in this study subjects. Plasma BNP levels and the crude (median value, 17.2 vs. 14.1 m/s, p < 0.01) and adjusted value of baPWV were significantly higher in subjects with overlap syndrome than in those with OSA alone. However, parameters of nocturnal hypoxemia and serum CRP levels were similar between both groups. Thus, the overlap of COPD in patients with OSA augments increase in arterial stiffness without the exaggeration of nocturnal hypoxemia and inflammation. Even so, this augmentation may partially contribute to the increased cardiovascular risk in the overlap syndrome.
慢性阻塞性肺疾病（COPD）和阻塞性睡眠呼吸暂停（OSA）最近被广泛认为是心血管疾病的独立危险因素。此外，与仅患有其中一种疾病的患者相比，这两种疾病的并发症预后更差。然而，这种预后恶化的潜在机制细节尚不清楚。本横断面研究旨在探讨 COPD 重叠是否会增加 OSA 患者的动脉僵硬程度。如果是这样，我们检查了夜间低氧血症的加剧及其相关炎症是否与这种动脉僵硬程度增加的加剧有关。在通过多导睡眠图诊断为 OSA 的 524 名男性受试者（呼吸暂停低通气指数> 5/h）（52 ± 14 岁）中，测量了 1 秒用力呼气量/用力肺活量（FEV1/FVC）比、肱踝脉搏波速度（baPWV）、血液 C 反应蛋白（CRP）和 B 型利钠肽（BNP）水平。在本研究中，COPD 的患病率为 12%。与单纯 OSA 患者相比，重叠综合征患者的血浆 BNP 水平以及未经校正（中位数，17.2 比 14.1 m/s，p < 0.01）和校正后的 baPWV 值均显着升高。然而，两组的夜间低氧血症参数和血清 CRP 水平相似。因此，在 OSA 患者中 COPD 的重叠会增加动脉僵硬，而不会加剧夜间低氧血症和炎症。即便如此，这种增加可能部分导致重叠综合征中心血管风险的增加。
