Schreiber Annia, Surbone Sara, Malovini Alberto, Mancini Marco, Cemmi Francesca, Piaggi Giancarlo, Ceriana Piero, Carlucci Annalisa
Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy.
Unità Operativa di Pneumologia, Ospedale Asilo Vittoria di Mortara, Azienda Socio Sanitaria Territoriale di Pavia, Italy.
J Thorac Dis. 2018 Dec;10(12):6819-6827. doi: 10.21037/jtd.2018.10.103.
The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), also referred to as overlap syndrome (OS), is associated with a high rate of morbidity, COPD exacerbations and mortality. Treatment with continuous positive airway pressure (CPAP) has proven to significantly decrease the rate of these complications. However, data concerning the effect of CPAP on pulmonary function are scarce and conflicting. The aim of our study was to evaluate the effect of 1 year of CPAP treatment on arterial blood gases (ABGs) and pulmonary function tests in patients with OS and its potential relationship with the baseline severity of airway obstruction. A secondary aim was to search for predictors of changes in the evaluated parameters.
A retrospective study on a cohort of 92 patients (74 males) discharged from the Pulmonary Rehabilitation Unit of the Istituti Clinici Scientifici Maugeri in Pavia (Italy) from January 2013 to January 2016, with a diagnosis of OS and a prescription of CPAP, was conducted. Collected data at discharge were compared with 1-year follow-up data.
After 1 year of CPAP, we observed the following: (I) a significant improvement in ABGs in all patients [median pO 65.0 (59.0-70.0) 71 (64.8-77.1) mmHg, pCO 39.8 (36.2-43.5) 38.3 (32.3-44.2) at baseline and after 1 year respectively, P<0.001], which was more pronounced in patients who were hypercapnic at baseline; (II) no significant change in respiratory function in the whole population; (III) a significant change in forced expiratory volume in 1 second (FEV) only under and above a threshold of 79.1% of basal FEV with an opposite trend. In particular, patients with a basal FEV below that threshold significantly improved [median FEV 70 (-70 to 200) mL, P=0.001], whereas patients with a basal FEV above the same threshold significantly worsened [median FEV -270 (-370 to -130) mL, P=3.05×10].
A population of overlap patients treated with CPAP may experience a different change in airflow obstruction after 1 year depending on the severity of baseline obstruction.
慢性阻塞性肺疾病（COPD）与阻塞性睡眠呼吸暂停（OSA）并存，即重叠综合征（OS），与高发病率、COPD急性加重和死亡率相关。持续气道正压通气（CPAP）治疗已被证明可显著降低这些并发症的发生率。然而，关于CPAP对肺功能影响的数据稀少且相互矛盾。我们研究的目的是评估1年CPAP治疗对OS患者动脉血气（ABG）和肺功能测试的影响及其与气道阻塞基线严重程度的潜在关系。次要目的是寻找评估参数变化的预测因素。
对2013年1月至2016年1月从意大利帕维亚的Istituti Clinici Scientifici Maugeri肺康复科出院的92例患者（74例男性）进行回顾性研究，这些患者诊断为OS并开具了CPAP处方。将出院时收集的数据与1年随访数据进行比较。
CPAP治疗1年后，我们观察到以下情况：（I）所有患者的ABG均有显著改善[基线时和1年后的中位数pO₂分别为65.0（59.0 - 70.0）mmHg和71（64.8 - 77.1）mmHg，pCO₂分别为39.8（36.2 - 43.5）mmHg和38.3（32.3 - 44.2）mmHg，P<0.001]，在基线时高碳酸血症患者中更为明显；（II）整个人群的呼吸功能无显著变化；（III）仅在基础第1秒用力呼气容积（FEV₁）的79.1%阈值上下，FEV₁有显著变化，且趋势相反。具体而言，基础FEV₁低于该阈值的患者有显著改善[中位数FEV₁为70（-70至200）mL，P = 0.001]，而基础FEV₁高于同一阈值的患者则显著恶化[中位数FEV₁为 - 270（-370至 - 130）mL，P = 3.05×10⁻⁴]。
接受CPAP治疗的重叠综合征患者群体在1年后气流阻塞可能会因基线阻塞的严重程度而发生不同变化。
