Jaoude Philippe, El-Solh Ali A
The Veterans Affairs Western New York Healthcare System, Buffalo, New York.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacob School of Medicine, University at Buffalo, Buffalo, New York.
Clin Respir J. 2019 Oct;13(10):643-651. doi: 10.1111/crj.13079. Epub 2019 Aug 27.
Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA)-overlap syndrome-have a substantially greater risk of morbidity and mortality, compared to those with either COPD or OSA alone.
The aim of this retrospective study was to identify clinical modifiable factors associated with COPD exacerbations and all-cause mortality in patients with overlap syndrome.
The electronic records of patients with simultaneous COPD and OSA who had a documented acute exacerbation of COPD during a 42-month period were evaluated for reviewed. A control group of overlap syndrome patients without exacerbations was matched 1:1 for age and body mass index. Vital status and cause of death were assessed through the population death registry.
Out of 225 eligible cases, 92 patients had at least one episode of COPD exacerbation. There was no significant association between severity of airflow limitation and apnoea hypopnea index (P = .31). After adjusting for confounding variables, patients who had at least one COPD exacerbation were more likely to be active smokers (P = .01), have poorer lung function (P = .001) and less likely to adhere to continuous positive airway pressure (CPAP) use (P = .03). All-cause mortality was also correlated with low forced expiratory volume in 1 second (P = .006), CPAP use (P = .007), and burden of comorbidities (P < .001).
Lung function and CPAP use were independent predictors of COPD exacerbations and all-cause mortality in a cohort of patients with overlap syndrome. These factors should be taken into account when considering the management and prognosis of these patients.
与单纯患有慢性阻塞性肺疾病（COPD）或阻塞性睡眠呼吸暂停（OSA）的患者相比，患有COPD和OSA重叠综合征的患者发病和死亡风险显著更高。
这项回顾性研究的目的是确定重叠综合征患者中与COPD急性加重和全因死亡率相关的临床可改变因素。
对在42个月期间有COPD急性加重记录的同时患有COPD和OSA的患者的电子记录进行评估。将一组无急性加重的重叠综合征患者按年龄和体重指数1:1匹配作为对照组。通过人口死亡登记处评估生命状态和死亡原因。
在225例符合条件的病例中，92例患者至少有一次COPD急性加重。气流受限严重程度与呼吸暂停低通气指数之间无显著关联（P = 0.31）。在对混杂变量进行调整后，至少有一次COPD急性加重的患者更可能是现吸烟者（P = 0.01）、肺功能较差（P = 0.001）且不太可能坚持使用持续气道正压通气（CPAP）（P = 0.03）。全因死亡率也与第1秒用力呼气量低（P = 0.006）、使用CPAP（P = 0.007）以及合并症负担（P < 0.001）相关。
在重叠综合征患者队列中，肺功能和CPAP使用是COPD急性加重和全因死亡率的独立预测因素。在考虑这些患者的管理和预后时应考虑这些因素。
