阻塞性睡眠呼吸暂停对慢性阻塞性肺疾病患者肺动脉高压的影响。
Impact of obstructive sleep apnea on pulmonary hypertension in patients with chronic obstructive pulmonary disease.
机构信息
Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Peking University, Beijing 100191, China.
Department of Respiratory Medicine, Cixi People's Hospital, Cixi, Zhejiang 315300, China.
出版信息
Chin Med J (Engl). 2019 Jun 5;132(11):1272-1282. doi: 10.1097/CM9.0000000000000247.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) syndrome are highly prevalent respiratory conditions. Their coexistence is referred to as the overlap syndrome. They are both related to pulmonary hypertension (PH) development. This study investigated the effects of OSA on PH in patients with COPD and the associated factors.
METHODS
Consecutive patients with stable COPD were recruited for an observational cross-sectional study from September 2016 to May 2018 at Peking University Third Hospital. In total, 106 patients with COPD were enrolled and performed home portable monitoring and echocardiography. OSA was defined by an apnea hypopnea index (AHI) ≥10 events/h. Based on OSA absence or presence, patients were divided into the COPD with OSA and COPD without OSA groups. Factors affecting pulmonary artery pressure (PAP) and PH were identified using univariate analysis and logistic regression models.
RESULTS
In the 106 patients with COPD, the mean age was 69.52 years, 91.5% were men, and the mean forced expiratory volume in 1 s (FEV1) percentage of predicted was 56.15%. Fifty-six (52.8%) patients with COPD were diagnosed with OSA, and 24 (22.6%) patients with COPD were diagnosed as PH. Compared with COPD without OSA group, the median PAP in COPD with severe OSA group increased by 5 mmHg (36.00 [26.00-50.00] mmHg vs. 31.00 [24.00-34.00] mmHg, P = 0.036). COPD with percent of night-time spent with oxygen saturation below 90% (T90) > 10% group had higher PAP than COPD with T90 ≤ 1% group (36.00 [29.00-50.00)] mmHg vs. 29.00 [25.50-34.00] mmHg, F = 7.889, P = 0.007). Univariate analysis revealed age, FEV1% predicted, T90, and Charlson index had statistically significant effects on PH. Multiple regression analysis showed a significant and independent effect of both FEV1% predicted (odds ratio [OR] = 3.46; 95% confidence interval [CI]: 1.15-10.46; P = 0.028) and AHI (OR = 3.20; 95% CI: 1.09-19.35; P = 0.034) on PH.
CONCLUSIONS
Patients with COPD with OSA are more susceptible to PH, which is associated with declining lung function and increased severity of OSA. Thus, nocturnal hypoxemia and OSA in elderly patients with COPD should be identified and treated.
背景
慢性阻塞性肺疾病（COPD）和阻塞性睡眠呼吸暂停（OSA）综合征是两种常见的呼吸系统疾病。这两种疾病同时存在被称为重叠综合征。它们都与肺动脉高压（PH）的发展有关。本研究旨在探讨 OSA 对 COPD 患者 PH 的影响及其相关因素。
方法
本研究采用观察性横断面研究方法，连续纳入 2016 年 9 月至 2018 年 5 月期间于北京大学第三医院就诊的稳定期 COPD 患者。共纳入 106 例 COPD 患者，进行家庭便携式监测和超声心动图检查。OSA 定义为呼吸暂停低通气指数（AHI）≥10 次/小时。根据 OSA 的有无，将患者分为 COPD 合并 OSA 组和 COPD 不合并 OSA 组。采用单因素分析和 logistic 回归模型确定影响肺动脉压（PAP）和 PH 的因素。
结果
106 例 COPD 患者中，平均年龄为 69.52 岁，91.5%为男性，用力肺活量占预计值百分比（FEV1%pred）的平均值为 56.15%。56 例（52.8%）COPD 患者被诊断为 OSA，24 例（22.6%）COPD 患者被诊断为 PH。与 COPD 不合并 OSA 组相比，重度 OSA 组的 PAP 中位数增加了 5mmHg（36.00[26.00-50.00]mmHg 比 31.00[24.00-34.00]mmHg，P=0.036）。夜间血氧饱和度低于 90%（T90）的时间百分比（T90）>10%的 COPD 患者的 PAP 高于 T90≤1%的患者（36.00[29.00-50.00]mmHg 比 29.00[25.50-34.00]mmHg，F=7.889，P=0.007）。单因素分析显示，年龄、FEV1%pred、T90 和 Charlson 指数对 PH 有统计学意义。多因素回归分析显示，FEV1%pred（比值比[OR]：3.46；95%置信区间[CI]：1.15-10.46；P=0.028）和 AHI（OR：3.20；95%CI：1.09-19.35；P=0.034）均对 PH 有显著独立影响。
结论
合并 OSA 的 COPD 患者更易发生 PH，这与肺功能下降和 OSA 严重程度增加有关。因此，应识别和治疗老年 COPD 患者的夜间低氧血症和 OSA。
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