Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Atlanta, GA 30033, USA.
Respirology. 2013 Apr;18(3):421-31. doi: 10.1111/resp.12062.
Obstructive lung diseases (OLD) such as asthma and chronic obstructive pulmonary disease (COPD) are very prevalent conditions. Disease phenotypes (e.g. chronic bronchitis, emphysema, etc.) often overlap, and significant confusion exists about their optimal nosologic characterization. Obstructive sleep apnoea (OSA) is also a common condition that features bidirectional interactions with OLD. OSA appears to be more commonly seen in patients with OLD, perhaps as a result of shared risk factors, for example obesity, smoking, increased airway resistance, local and systemic inflammation, anti-inflammatory therapy. Conversely, OSA is associated with worse clinical outcomes in patients with OLD, and continuous positive airway pressure therapy has potential beneficial effects on this vicious pathophysiological interaction. Possible shared mechanistic links include increased parasympathetic tone, hypoxaemia-related reflex bronchoconstriction/vasoconstriction, irritation of upper airway neural receptors, altered nocturnal neurohormonal secretion, pro-inflammatory mediators, within and inter-breath interactions between upper and lower airways, lung volume-airway dependence, etc. While the term overlap syndrome has been defined as the comorbid association of COPD and OSA, the interaction between asthma and OSA has not been integrated yet nosologically; in this review, the latter will be called alternative overlap syndrome. In an effort to bolster further investigations in this area, an integrated, lumping nomenclature for OSA in the setting of OLD is proposed here--OLDOSA (obstructive lung disease and obstructive sleep apnoea) syndrome.
阻塞性肺疾病（OLD），如哮喘和慢性阻塞性肺疾病（COPD），是非常普遍的疾病。疾病表型（如慢性支气管炎、肺气肿等）经常重叠，其最佳分类特征存在很大的混淆。阻塞性睡眠呼吸暂停（OSA）也是一种常见疾病，与 OLD 呈双向相互作用。OSA 似乎在 OLD 患者中更为常见，这可能是由于共同的危险因素，如肥胖、吸烟、气道阻力增加、局部和全身炎症、抗炎治疗。相反，OSA 与 OLD 患者的临床预后更差有关，持续气道正压通气治疗对这种恶性循环的病理生理相互作用可能有潜在的有益影响。可能存在共同的机制联系，包括副交感神经张力增加、低氧相关反射性支气管收缩/血管收缩、上气道神经受体刺激、夜间神经激素分泌改变、促炎介质、上下气道之间的呼吸内和呼吸间相互作用、肺容积-气道依赖性等。虽然重叠综合征一词被定义为 COPD 和 OSA 的共病关联，但哮喘和 OSA 之间的相互作用尚未在分类学上得到整合；在这篇综述中，后者将被称为替代重叠综合征。为了进一步加强该领域的研究，这里提出了一种 OLD 中 OSA 的综合、合并命名法——OLDOSA（阻塞性肺病和阻塞性睡眠呼吸暂停）综合征。
