Maricić Lana, Visević Roberta, Vceva Andrijana, Vcev Aleksandar, Labor Slavica
Acta Med Croatica. 2013 Jun;67(3):219-24.
The objective of this study was to examine the risk of sleep apnea syndrome in patients with chronic obstructive pulmonary disease (COPD) and to determine correlation with the associated cardiovascular comorbidity in these patients. Chronic and occasional sleep disturbances represent a problem for millions of people worldwide. COPD is a multisystem disease and the leading cause of mortality and morbidity in the world. It is estimated that it will be the third cause of death in the world by 2020. Poor quality of sleep in patients with COPD occurs as a result of reduced oxygen saturation, hypercapnia, and the use of auxiliary respiratory muscles.
The study included 47 patients with COPD, examined at the Department of Pulmonology, Clinical Department of Internal Medicine, Osijek University Hospital Center in 2011. The respondents answered questions from the Croatian version of the Snoring, Tired, Observed, Pressure (STOP) questionnaire, which examines the risk of sleep apnea syndrome, and the Epworth Sleepiness Scale, which examines excessive daytime sleepiness. The respondents also provided data related to the current smoking status, bronchodilation therapy they apply at home, the associated cardiovascular comorbidity related to coronary heart disease (previous myocardial infarction, angina pectoris), cerebrovascular incident, diabetes, asthma, gastroesophageal reflux disease (GERD) and anxiety-depressive disorder.
According to the STOP questionnaire, the risk of sleep apnea syndrome was recorded in 35 (74.5%) respondents. Patients at risk had a higher frequency of comorbidities such as hypertension, diabetes mellitus type 2 and GERD. Excessive daytime sleepiness was recorded in 14.9% of patients with COPD and the mean daytime sleepiness scored 4.76 points. In patients at a high risk according to the STOP questionnaire, the mean daytime sleepiness was 6.24 points versus 3.72 points in the group at a low risk. Snoring was present in 23 (49%), excessive tiredness in 27 (57%), and cessation of breathing during sleep in every other person in 4 cases (8.5% of patients). The t-test showed no significant differences in oxygen saturation, partial O2 and CO2 pressures between the groups of non-risk and high-risk patients according to the STOP questionnaire.
For assessing the risk of sleep apnea syndrome in patients with COPD, the STOP questionnaire as a screening method has a significant role. Because of the high risk of sleep apnea syndrome in patients with COPD and considering the high level of associated cardiovascular comorbidity, it is necessary to perform polysomnography in patients at risk for timely detection and treatment of the syndrome, thus preventing its harmful consequences, with special reference to reduction of mortality in this population.
本研究的目的是检查慢性阻塞性肺疾病（COPD）患者睡眠呼吸暂停综合征的风险，并确定这些患者中与相关心血管合并症的相关性。慢性和偶尔的睡眠障碍是全球数百万人面临的问题。COPD是一种多系统疾病，是全球死亡率和发病率的主要原因。据估计，到2020年它将成为全球第三大死因。COPD患者睡眠质量差是由于氧饱和度降低、高碳酸血症以及辅助呼吸肌的使用。
该研究纳入了47例COPD患者，于2011年在奥西耶克大学医院中心内科临床肺病科进行检查。受访者回答了克罗地亚语版的打鼾、疲倦、观察、压力（STOP）问卷中的问题，该问卷用于检查睡眠呼吸暂停综合征的风险，以及Epworth嗜睡量表，用于检查白天过度嗜睡情况。受访者还提供了与当前吸烟状况、在家中应用的支气管扩张治疗、与冠心病相关的心血管合并症（既往心肌梗死、心绞痛）、脑血管事件、糖尿病、哮喘、胃食管反流病（GERD）和焦虑抑郁障碍相关的数据。
根据STOP问卷，35名（74.5%）受访者记录有睡眠呼吸暂停综合征风险。有风险的患者合并症如高血压、2型糖尿病和GERD的发生率更高。14.9%的COPD患者记录有白天过度嗜睡，平均白天嗜睡评分为4.76分。根据STOP问卷，高风险患者的平均白天嗜睡评分为6.24分，而低风险组为3.72分。23名（49%）患者打鼾，27名（57%）患者过度疲倦，4例患者（8.5%）每两人中就有一人睡眠期间呼吸暂停。t检验显示，根据STOP问卷，非风险组和高风险组患者之间的氧饱和度、氧分压和二氧化碳分压无显著差异。
对于评估COPD患者睡眠呼吸暂停综合征的风险，STOP问卷作为一种筛查方法具有重要作用。由于COPD患者睡眠呼吸暂停综合征风险高，且考虑到相关心血管合并症水平高，有必要对有风险的患者进行多导睡眠图检查，以便及时发现和治疗该综合征，从而预防其有害后果，特别是降低该人群的死亡率。
