He Baiting, Al-Sherif Miral, Wu Yingxin, Higgins Sean, Schwarz Esther Irene, Luo Yuanming, Said Azza Farag, Refat Nezar, Abdel Wahab Nashwa Hassan, Steier Joerg
Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.
King's College London, Faculty of Life sciences and Medicine, Centre of Human and Applied Physiological Sciences (CHAPS), UK.
J Thorac Dis. 2020 Oct;12(Suppl 2):S112-S119. doi: 10.21037/jtd-cus-2020-008.
In 2007 and 2012, the American Academy of Sleep Medicine (AASM) updated their scoring criteria for nocturnal respiratory events. We hypothesised that this could have led to changes in the apnoea-hypopnoea index (AHI) of patients with chronic obstructive pulmonary disease (COPD)/obstructive sleep apnoea (OSA) overlap syndrome.
In a retrospective study, polysomnographic (PSG) recordings of 34 patients with COPD/OSA overlap syndrome were independently analysed using the AASM criteria from 2007 (AASM) and 2012 (AASM). The primary outcome was the difference in AHI, the secondary outcomes were frequency of hypopnoeas, diagnosis of overlap syndrome and differences between the AASM 2007 recommended (AASM) and altered (AASM) classifications. Data are presented as mean (standard deviation) if normally distributed, and as median (interquartile range) if non-normally distributed.
The PSGs of 34 elderly [aged 67 (7.0) years] and predominantly male (m:f, 31:3) patients with COPD [FEV%pred 48.4% (19.6%)] were analysed. The AHI using AASM criteria was 5.9 (2.0, 15.1) events/hour 20.4 (11.5, 28.0) events/hour using the 2012 criteria (P<0.001); with the AASM criteria, the AHI was 15.0 (9.3, 26.3) events/hour (P<0.001). Using the 2012 classification, the number of scored hypopnoeas increased by +48% compared to the AASM criteria (P<0.001), 92% of these events were associated with arousal. Although statistically non-significant, using the AASM classification, 12% of our cohort would not have been diagnosed with COPD/OSA overlap syndrome (P=0.114), this was also the case for 47% of the cohort when the AASM classification was used (P<0.01).
The use of the AASM scoring rules results in a significantly higher AHI compared to the AASM criteria in patients with COPD/OSA overlap syndrome, mostly due to an increased number of arousal-associated hypopnoeas. These observations are important for the definition of the COPD/OSA overlap syndrome.
2007年和2012年，美国睡眠医学学会（AASM）更新了夜间呼吸事件的评分标准。我们推测这可能导致慢性阻塞性肺疾病（COPD）/阻塞性睡眠呼吸暂停（OSA）重叠综合征患者的呼吸暂停低通气指数（AHI）发生变化。
在一项回顾性研究中，对34例COPD/OSA重叠综合征患者的多导睡眠图（PSG）记录分别采用2007年（AASM）和2012年（AASM）的AASM标准进行独立分析。主要结局指标是AHI的差异，次要结局指标是低通气的频率、重叠综合征的诊断以及2007年AASM推荐标准（AASM）与修订标准（AASM）之间的差异。数据若呈正态分布则以均值（标准差）表示，若呈非正态分布则以中位数（四分位数间距）表示。
分析了34例老年患者[年龄67（7.0）岁]，以男性为主（男∶女为31∶3），患有COPD[预计第一秒用力呼气容积（FEV₁%pred）为48.4%（19.6%）]。采用AASM标准时AHI为5.9（2.0，15.1）次/小时，采用2012年标准时为20.4（11.5，28.0）次/小时（P<0.001）；采用AASM标准时，AHI为15.0（9.3，26.3）次/小时（P<0.001）。采用2012年分类标准时，与AASM标准相比，低通气评分次数增加了48%（P<0.001），其中92%的此类事件与觉醒相关。尽管在统计学上无显著差异，但采用AASM分类标准时，我们队列中有12%的患者不会被诊断为COPD/OSA重叠综合征（P=0.114），采用AASM分类标准时该比例为47%（P<0.01）。
在COPD/OSA重叠综合征患者中，与AASM标准相比，采用AASM评分规则导致AHI显著更高，这主要是由于与觉醒相关的低通气次数增加。这些观察结果对于COPD/OSA重叠综合征的定义很重要。
