Xiong M Q, Hu W H, Hu K, Zheng Z S, Dong M L, Mo H H, He J G
Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peaking Union Medical College, Beijing 100037, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2019 Nov 12;42(11):832-837. doi: 10.3760/cma.j.issn.1001-0939.2019.11.009.
To compare clinical characteristics between patients with chronic obstructive pulmonary disease (COPD) and COPD -OSA overlap, and to analyze the risk factors for OSA in patients with COPD. A total of 431 patients with COPD were divided into a COPD-OSA group with AHI>15 events/h or a COPD group with AHI ≤ 15 events/h according to the results of polysomnography, and their clinical characteristics were summarized. Risk factors for OSA overlap in COPD patients were identified by univariate and multivariate logistic regression analyses. There were no significant differences in gender composition, dyspnea scale (mMRC) score, the numbers of acute exacerbations and hospitalizations in the last year, prevalence of coronary heart disease, or cor pulmonale or diabetes mellitus in the two groups (all 0.05). Age, BMI, neck circumference, smoking index, COPD assessment test (CAT) score, the values of FEV(1) or FEV(1)%, FEV(1)/FVC ratios, and the prevalence of hypertension in the COPD-OSA group with AHI>15 events/h were significantly higher than in the COPD group with AHI ≤15 events/h, while the duration of COPD and the proportion of severe COPD were lower than the COPD group with AHI≤ 15 (0.05). The scores of Charlson Comorbidity Index, Epworth Sleepiness Scale (ESS) and Sleep Apnea Clinical Score (SACS) in the COPD-OSA group were significantly higher than in the COPD group with AHI≤ 15, with all values<0.05. Risk factors for AHI>15 OSA coinciding in patients with COPD included BMI, neck circumference, ESS, SACS and CAT (0.05). Furthermore, BMI, ESS and CAT were independent risk factors for OSA in COPD patients (0.05). Compared with mild or moderate COPD cases, patients with severe COPD (FEV(1)%<50%) had a lower risk of having OSA (β=-0.459, 0.632, 95% 0.401-0.997, 0.048). Compared to COPD patients with AHI ≤ 15 events/h, OSA-COPD overlap patients (AHI>15 events/h) had a worse quality of life, more daytime sleepiness and higher prevalence of hypertension. BMI, ESS and CAT were independent risk factors for AHI>15 OSA in patients with COPD. The risk of having OSA in severe COPD patients was lower than cases with mild or moderate COPD.
比较慢性阻塞性肺疾病（COPD）患者与COPD-阻塞性睡眠呼吸暂停（OSA）重叠综合征患者的临床特征，并分析COPD患者发生OSA的危险因素。根据多导睡眠图结果，将431例COPD患者分为呼吸暂停低通气指数（AHI）>15次/小时的COPD-OSA组和AHI≤15次/小时的COPD组，并总结其临床特征。通过单因素和多因素逻辑回归分析确定COPD患者中OSA重叠综合征的危险因素。两组在性别构成、呼吸困难量表（mMRC）评分、去年急性加重次数和住院次数、冠心病患病率、肺心病或糖尿病患病率方面均无显著差异（均P>0.05）。AHI>15次/小时的COPD-OSA组患者的年龄、体重指数（BMI）、颈围、吸烟指数、COPD评估测试（CAT）评分、第1秒用力呼气容积（FEV₁）或FEV₁%值、FEV₁/用力肺活量（FVC）比值以及高血压患病率均显著高于AHI≤15次/小时的COPD组，而COPD病程和重度COPD比例低于AHI≤15次/小时的COPD组（P<0.05）。COPD-OSA组的查尔森合并症指数、爱泼华嗜睡量表（ESS）和睡眠呼吸暂停临床评分（SACS）均显著高于AHI≤15次/小时的COPD组，所有P值均<0.05。COPD患者中AHI>15的OSA重叠综合征的危险因素包括BMI、颈围、ESS、SACS和CAT（P<0.05）。此外，BMI、ESS和CAT是COPD患者发生OSA的独立危险因素（P<0.05）。与轻度或中度COPD病例相比，重度COPD（FEV₁%<50%）患者发生OSA的风险较低（β=-0.459，P=0.632，95%CI：0.401-0.997，P=0.048）。与AHI≤15次/小时的COPD患者相比，OSA-COPD重叠综合征患者（AHI>15次/小时）的生活质量更差、白天嗜睡更明显且高血压患病率更高。BMI、ESS和CAT是COPD患者AHI>15的OSA的独立危险因素。重度COPD患者发生OSA的风险低于轻度或中度COPD患者。
