1 Sleep Disorders Center, Detroit Medical Center, Detroit, Michigan.
2 Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan.
Ann Am Thorac Soc. 2016 Jan;13(1):86-92. doi: 10.1513/AnnalsATS.201507-413OC.
Sleep-disordered breathing and chronic obstructive pulmonary disease are two common conditions that may present concomitantly. The effects of chronic obstructive pulmonary disease on the polysomnographic manifestation of sleep-disordered breathing have not been studied.
We hypothesized that the presence of airflow obstruction could be predicted by the presence of expiratory upper airway narrowing during sleep in patients with sleep-disordered breathing.
Ninety-three patients with sleep-disordered breathing (19 men; age, 51.6 yr; body mass index, 40.1 kg/m(2); apnea-hypopnea index, 37.4 events/h) were observed. Every patient had an in-lab polysomnography study and complete pulmonary function tests. Sleep and respiratory events were scored using American Academy of Sleep Medicine recommended scoring criteria. Expiratory snoring events were identified on polysomnography using microphone sensor and/or pressure flow sensor in each patient. The FEV1/FVC ratio less than 70 was used to define the presence of airflow obstruction.
The proportion analysis demonstrated that patients with expiratory snoring have 11 times higher odds of having evidence of lower airway obstruction, defined as FEV1/FVC less than 70 (odds ratio [OR], 11.03; P < 0.001), whereas smokers have increased odds by 13 times (OR, 13.18; P < 0.001). Spearman correlation analysis showed that FEV1 was positively related to mean SaO2 (P < 0.05) and negatively related to expiratory snoring, smoking, 3% oxygen desaturation index, 2% oxygen desaturation index, and age (P < 0.05). Epworth sleepiness scale, sex, and body mass index did not have any association with FEV1. The multiple logistic regression analysis demonstrated that chronic obstructive pulmonary disease (FEV1/FVC < 70) correlated significantly with expiratory snoring and smoking (OR, 11.76; confidence interval, 3.23-42.83; and OR, 9.95; confidence interval, 2.67-37.09), respectively. The multiple linear regression analysis revealed that the linear combination of mean SaO2 and expiratory snoring (P < 0.05) predicted FEV1. However, age and 2% oxygen desaturation index did not predict FEV1.
The presence of expiratory snoring predicts obstructive airway disorders. Patients with expiratory snoring and low mean oxygen saturation during sleep should be carefully assessed for pulmonary disorders such as asthma and chronic obstructive pulmonary disease.
睡眠呼吸紊乱和慢性阻塞性肺疾病是两种常见的疾病，可能同时存在。慢性阻塞性肺疾病对睡眠呼吸紊乱的多导睡眠图表现的影响尚未得到研究。
我们假设在睡眠呼吸紊乱患者中，呼气性上气道狭窄的存在可以预测气流阻塞的存在。
观察了 93 例睡眠呼吸紊乱患者（19 名男性；年龄 51.6 岁；体重指数 40.1 kg/m2；呼吸暂停低通气指数 37.4 次/小时）。每位患者均进行了实验室多导睡眠图检查和完整的肺功能检查。睡眠和呼吸事件的评分使用美国睡眠医学学会推荐的评分标准进行。使用麦克风传感器和/或每个患者的压力流量传感器在多导睡眠图上识别呼气性打鼾事件。FEV1/FVC 比值<70 定义为气流受限。
比例分析表明，有呼气性打鼾的患者发生下气道阻塞（定义为 FEV1/FVC<70）的可能性高 11 倍（比值比[OR]，11.03；P<0.001），而吸烟者的可能性高 13 倍（OR，13.18；P<0.001）。Spearman 相关分析显示，FEV1 与平均 SaO2 呈正相关（P<0.05），与呼气性打鼾、吸烟、3%氧减饱和指数、2%氧减饱和指数和年龄呈负相关（P<0.05）。Epworth 嗜睡量表、性别和体重指数与 FEV1 无任何关联。多元逻辑回归分析表明，慢性阻塞性肺疾病（FEV1/FVC<70）与呼气性打鼾和吸烟显著相关（OR，11.76；置信区间，3.23-42.83；OR，9.95；置信区间，2.67-37.09）。多元线性回归分析显示，平均 SaO2 和呼气性打鼾的线性组合（P<0.05）可以预测 FEV1。然而，年龄和 2%氧减饱和指数不能预测 FEV1。
呼气性打鼾的存在预测阻塞性气道疾病。有呼气性打鼾和睡眠时平均氧饱和度降低的患者应仔细评估哮喘和慢性阻塞性肺疾病等肺部疾病。
