Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD 21201, USA.
J Clin Sleep Med. 2013 Jul 15;9(7):687-93. doi: 10.5664/jcsm.2840.
Little is known about the rate of obstructive sleep apnea (OSA) in patients with end stage lung disease (ESLD). Given the potential deleterious effect of OSA in these patients, we assessed the case-rate and severity of OSA and described associated patient characteristics.
Retrospective survey of 60 patients with ESLD referred for lung transplantation evaluation. Demographic, polysomnographic, spirometric, and medication utilization data were extracted and analyzed.
As demographic and polysomnographic data did not differ between obstructive and restrictive patients, we present analysis of pooled data. Demographics/physiology: median age was 58.5 years, 52% males, mean BMI 32.3 kg/m(2), 52% obstructive. Sleep variables (all medians): total sleep time (TST) 312 min, sleep efficiency 77%, minimal oxygen saturation 84%, apnea hypopnea (AHI) 9.7, respiratory disturbance index (RDI) 12.7 events/h of sleep. Sixty-seven percent had RDI > 5; 21% had RDI between 15 and 30; and 21% had RDI > 30. Periodic limb movement index ≥ 15/h sleep was present in 21.7%. An independent positive correlation between DLCO% and RDI was noted (r = 0.41, p < 0.01). The minimal oxygen saturation was negatively correlated with the RDI (r = -0.34, p < 0.01). The use of ACE inhibitors was associated with moderate-to-severe OSA (odd ratio of 4.67, CI 1.45-15.03; p = 0.017).
In patients with ESLD, organic sleep disorders are common. Greater severity of OSA was associated with the higher DLCO% and lower oxygen saturation.
终末期肺病（ESLD）患者阻塞性睡眠呼吸暂停（OSA）的发生率知之甚少。鉴于 OSA 对这些患者可能产生的有害影响，我们评估了 OSA 的发病情况和严重程度，并描述了相关的患者特征。
回顾性调查了 60 名接受肺移植评估的 ESLD 患者。提取并分析了人口统计学、多导睡眠图、肺功能和药物使用数据。
由于阻塞性和限制性患者的人口统计学和多导睡眠图数据没有差异，因此我们报告了汇总数据的分析结果。人口统计学/生理学：中位年龄为 58.5 岁，52%为男性，平均 BMI 为 32.3kg/m²，52%为阻塞性。睡眠变量（均为中位数）：总睡眠时间（TST）为 312 分钟，睡眠效率为 77%，最低氧饱和度为 84%，呼吸暂停低通气指数（AHI）为 9.7，呼吸干扰指数（RDI）为 12.7 次/小时的睡眠。67%的患者 RDI>5；21%的患者 RDI 在 15 到 30 之间；21%的患者 RDI>30。每小时睡眠中周期性肢体运动指数≥15 的患者占 21.7%。注意到 DLCO%与 RDI 之间存在独立的正相关（r=0.41，p<0.01）。最低氧饱和度与 RDI 呈负相关（r=-0.34，p<0.01）。使用血管紧张素转换酶抑制剂与中重度 OSA 相关（比值比为 4.67，CI 为 1.45-15.03；p=0.017）。
在 ESLD 患者中，有机睡眠障碍很常见。OSA 的严重程度越高，DLCO%越高，氧饱和度越低。
