Khare Parul, Talwar Ajana, Trivedi Anjali, Chandran Dinu S, Guleria Randeep, Jaryal Ashok K, Deepak K K
Indian J Physiol Pharmacol. 2016 Apr;60(2):155-166.
Post-occlusive reactive hyperemia (RH) is impaired in Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea (OSA). The aim of the present study was to examine systemic vascular response and endothelial function in patients of Overlap Syndrome (OS) of COPD and OSA and also to investigate whether OS has any additional effect on endothelial dysfunction when compared to dysfunction caused by COPD alone.
31 COPD patients and 13 healthy controls participated in the study. Overnight Polysomnogra was done to classify the patients into COPD only group (Apnea-Hypopnea Index <5) (n=15) and OS group (AHI >5) (n=16). Peripheral pulse waveform changes during reactive hyperemia were assessed using digital Photoplethysmography (PPG) technique in which pulse wave amplitude (PWA), Maximum slope of upstroke and Pulse Transit Time (PTT) were measured. C - reactive protein was assessed as marker of inflammation by ELISA.
Maximum percentage changes in PWA during RH were significantly lower in the both COPD group [20.34(12.02-34.07)] (p<0.001) and Overlap Syndrome group [10.96(6.21-21.49)] (p<0.0001) as compared to Controls [49.79(46.03-65.32)], whereas amplitude responses were not significantly different in the COPD and OS group (p>0.05). Maximum percentage change in slope of upstroke showed similar responses in the three groups. CRP levels (mg/) were raised in COPD [11.60(1.75-15.00] (p<0.001) and OS group 12.52(5.28- 15.70)) as compared to controls [0.59(0.58-0.91)]. Maximum percentage change in amplitude negatively correlated with serum CRP levels in COPD group (r=-0.557, p=0.03) and in OS group (r=-O.552, p= 0.02). FEV1% predicted positively correlated with maximum percentage change in amplitude in OS group(r=0.579, p=0.018). No correlation of AHI was found with any of the vascular function parameter in Overlap group.
The patients with Overlap Syndrome have systemic inflammation and impaired reactive hyperaemia response. However, no additive effect of OSA was observed on impaired RH in patients with co-existing COPD.
慢性阻塞性肺疾病（COPD）和阻塞性睡眠呼吸暂停（OSA）患者存在闭塞后反应性充血（RH）受损的情况。本研究旨在检测慢性阻塞性肺疾病和阻塞性睡眠呼吸暂停重叠综合征（OS）患者的全身血管反应和内皮功能，并调查与单纯慢性阻塞性肺疾病导致的功能障碍相比，重叠综合征是否对内皮功能障碍有任何额外影响。
31例慢性阻塞性肺疾病患者和13名健康对照者参与了本研究。通过夜间多导睡眠图将患者分为单纯慢性阻塞性肺疾病组（呼吸暂停低通气指数<5）（n = 15）和重叠综合征组（呼吸暂停低通气指数>5）（n = 16）。使用数字光电容积脉搏波描记法（PPG）技术评估反应性充血期间外周脉搏波形变化，测量脉搏波振幅（PWA）、上升支最大斜率和脉搏传输时间（PTT）。通过酶联免疫吸附测定法评估C反应蛋白作为炎症标志物。
与对照组[49.79（46.03 - 65.32）]相比，慢性阻塞性肺疾病组[20.34（12.02 - 34.07）]（p < 0.001）和重叠综合征组[10.96（6.21 - 21.49）]（p < 0.0001）在反应性充血期间脉搏波振幅的最大百分比变化均显著降低，而慢性阻塞性肺疾病组和重叠综合征组的振幅反应无显著差异（p > 0.05）。三组上升支最大斜率的最大百分比变化显示出相似的反应。与对照组[0.59（0.58 - ）]相比，慢性阻塞性肺疾病组[11.60（1.75 - 15.00）]（p < 0.001）和重叠综合征组[12.52（5.28 - 15.70）]（p < 0.0001）的C反应蛋白水平（mg/）升高。慢性阻塞性肺疾病组（r = -0.557，p = 0.03）和重叠综合征组（r = -0.552，p = 0.02）中，振幅的最大百分比变化与血清C反应蛋白水平呈负相关。重叠综合征组中，预测的第1秒用力呼气容积百分比（FEV1%）与振幅的最大百分比变化呈正相关（r = 0.579，p = 0.018）。在重叠组中，未发现呼吸暂停低通气指数与任何血管功能参数相关。
重叠综合征患者存在全身炎症和反应性充血反应受损的情况。然而，在合并慢性阻塞性肺疾病的患者中，未观察到阻塞性睡眠呼吸暂停对受损的反应性充血有额外影响。
