Division of Pneumology, Geneva University Hospitals, Geneva, Switzerland.
University of Geneva Faculty of Medicine, Geneva, Switzerland.
PLoS One. 2020 Jul 9;15(7):e0235331. doi: 10.1371/journal.pone.0235331. eCollection 2020.
More advanced knowledge is needed on how COPD alters the clinical presentation of obstructive sleep apnea (OSA) and how the association of both diseases, known as 'overlap syndrome' (OVS), impacts on cardiovascular health.
To investigate differences between patients with OVS and those with moderate-to-severe OSA alone.
A cross-sectional study conducted in the French National Sleep Apnea Registry between January 1997 and January 2017. Univariable and multivariable logistic regression models were used to compare OVS versus OSA alone on symptoms and cardiovascular health.
46,786 patients had moderate-to-severe OSA. Valid spirometry was available for 16,466 patients: 14,368 (87%) had moderate-to-severe OSA alone and 2098 (13%) had OVS. A lower proportion of OVS patients complained of snoring, morning headaches and excessive daytime sleepiness compared to OSA alone (median Epworth Sleepiness Scale score: 9 [interquartile range (IQR) 6-13] versus 10 (IQR 6-13), respectively; P <0.02). Similarly, a lower proportion of OVS patients (35.6% versus 39.4%, respectively; P <0.01) experienced sleepiness while driving. In contrast, 63.5% of the OVS population experienced nocturia compared to 58.0% of the OSA population (P<0.01). Apnea hypopnea index (36 [25; 52] vs 33.1 [23.3; 50]), oxygen desaturation index (28 [15; 48] vs 25.2 [14; 45]) and mean nocturnal SaO2 (92 [90; 93.8] vs 93 [91.3; 94]) were significantly more altered in the OVS group. Associated COPD had no effect on the prevalence of hypertension and stroke. After controlling for main confounders, COPD severity was associated in a dose-response relationship with a higher prevalence of coronary heart disease, heart failure and peripheral arteriopathy.
In adults with moderate-to-severe OSA, OVS was minimally symptomatic, but exhibited higher odds for prevalent coronary heart disease, heart failure and peripheral arteriopathy.
需要更多关于 COPD 如何改变阻塞性睡眠呼吸暂停（OSA）临床表现的知识，以及这两种疾病的合并，即“重叠综合征”（OVS），如何影响心血管健康。
研究 OVS 患者与单纯中重度 OSA 患者之间的差异。
这是一项在法国国家睡眠呼吸暂停登记处进行的横断面研究，时间为 1997 年 1 月至 2017 年 1 月。使用单变量和多变量逻辑回归模型比较 OVS 与单纯中重度 OSA。
46786 例患者患有中重度 OSA。可获得有效肺功能检查的患者有 16466 例：14368 例（87%）单纯患有中重度 OSA，2098 例（13%）患有 OVS。与单纯 OSA 相比，OVS 患者抱怨打鼾、晨起头痛和日间嗜睡的比例较低（中位 Epworth 睡眠量表评分：9 [四分位距 6-13] 与 10 [四分位距 6-13] ，P<0.02）。同样，在驾驶时感到困倦的 OVS 患者比例较低（分别为 35.6%和 39.4%，P<0.01）。相反，OVS 患者中有 63.5%的人夜间多尿，而 OSA 患者中仅有 58.0%的人夜间多尿（P<0.01）。呼吸暂停低通气指数（36 [25；52] 与 33.1 [23.3；50]）、氧减指数（28 [15；48] 与 25.2 [14；45]）和平均夜间 SaO2（92 [90；93.8] 与 93 [91.3；94]）在 OVS 组中明显更差。合并 COPD 对高血压和中风的患病率无影响。在控制主要混杂因素后，COPD 严重程度与冠心病、心力衰竭和外周血管病的患病率呈剂量反应关系。
在患有中重度 OSA 的成年人中，OVS 症状轻微，但冠心病、心力衰竭和外周血管病的患病率更高。
