重叠综合征中阻塞性睡眠呼吸暂停和慢性阻塞性肺疾病涉及的低唤醒阈值的多导睡眠图特征。

Polysomnographic features of low arousal threshold in overlap syndrome involving obstructive sleep apnea and chronic obstructive pulmonary disease.

机构信息

Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.

出版信息

Sleep Breath. 2019 Dec;23(4):1095-1100. doi: 10.1007/s11325-019-01786-7. Epub 2019 Jan 26.

DOI:10.1007/s11325-019-01786-7

PMID:30685846

Abstract

PURPOSE

In patients with overlap syndrome (OVS), the pathophysiologies of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease can interact with one another. Focusing on low arousal threshold, the authors evaluated polysomnographic features of OVS patients.

METHODS

This retrospective, multicenter study was conducted at three hospitals in Japan. Patients aged ≥ 60 years who underwent polysomnography and pulmonary function testing were reviewed. Severity of airflow limitation (AFL) was classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria. Low arousal threshold was predicted based on the following polysomnography features: lower apnea-hypopnea index (AHI); higher nadir oxygen saturation, and larger hypopnea fraction of total respiratory events. These features were compared among patients with only OSA (n = 126), OVS with mild AFL (n = 16), and OVS with moderate/severe AFL (n = 22).

RESULTS

A low arousal threshold was more frequently exhibited by OVS patients with moderate/severe AFL than by those with OSA only (p = 0.016) and OVS with mild AFL (p = 0.026). As forced expiratory volume in 1 s/forced vital capacity (FEV/FVC) decreased in OVS patients, the mean length of apnea decreased (r = 0.388, p = 0.016), hypopnea fractions increased (r = - 0.337, p = 0.039), and AHI decreased (r = 0.424, p = 0.008). FEV/FVC contributed to low arousal threshold independent of age, sex, smoking history, hospital, or body mass index in all subjects (OR 0.946 [95% CI 0.909-0.984]) and in OVS patients (OR 0.799 [95% CI 0.679-0.940]).

CONCLUSIONS

This study first described peculiar polysomnographic features in OVS patients with moderate/severe AFL, suggesting a high prevalence of low arousal threshold.

摘要

目的

重叠综合征（OVS）患者的阻塞性睡眠呼吸暂停（OSA）和慢性阻塞性肺疾病的病理生理学可以相互作用。作者关注低唤醒阈值，评估了 OVS 患者的多导睡眠图特征。

方法

本回顾性多中心研究在日本的三家医院进行。回顾性分析了接受多导睡眠图和肺功能检查且年龄≥60 岁的患者。根据全球慢性阻塞性肺疾病倡议标准，将气流受限严重程度（AFL）分为轻度、中度和重度。根据以下多导睡眠图特征预测低唤醒阈值：较低的呼吸暂停低通气指数（AHI）、更低的最低血氧饱和度和更大的呼吸事件中呼吸暂停的分数。比较了仅 OSA（n=126）、轻度 AFL 的 OVS（n=16）和中重度 AFL 的 OVS（n=22）患者之间的这些特征。

结果

与仅 OSA（p=0.016）和轻度 AFL 的 OVS（p=0.026）患者相比，中重度 AFL 的 OVS 患者更常表现出低唤醒阈值。随着 OVS 患者用力呼气量/用力肺活量（FEV/FVC）的降低，呼吸暂停的平均长度降低（r=0.388，p=0.016），呼吸暂停分数增加（r=-0.337，p=0.039），AHI 降低（r=0.424，p=0.008）。在所有受试者（OR 0.946 [95%CI 0.909-0.984]）和 OVS 患者（OR 0.799 [95%CI 0.679-0.940]）中，FEV/FVC 独立于年龄、性别、吸烟史、医院或体重指数对低唤醒阈值有贡献。