Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
UO Pneumologia, Azienda Policlinico-San Marco, Via S. Sofia, 95123, Catania, Italy.
Sleep Breath. 2023 Jun;27(3):1049-1055. doi: 10.1007/s11325-022-02702-2. Epub 2022 Sep 3.
The coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is known as "overlap syndrome" (OS). Patients with OS are usually older than patients with OSA alone, suffer from more profound oxygen desaturation during the obstructive events often accompanied by sustained nocturnal hypoventilation. Although oxygen-enriched positive airway pressure (PAP) is the treatment of choice in these patients, this therapy is often poorly tolerated particularly by the elderly. The aim of this study was to assess the usefulness of nocturnal oxygen therapy via nasal high flow (NHF-OT) as a possible alternative to PAP in patients with OS.
Patients > 65 years old with OS and nocturnal respiratory failure (time spent below SaO 90% (T90) > 30%) had cardio-respiratory monitoring performed at baseline, during NHF-OT, or during conventional oxygen therapy (COT).
A total of 40 patients were enrolled in the study. NHF-OT significantly reduced the apnea-hypopnea index (AHI) in all patients compared to baseline and COT. The mean basal AHI was 25.4 ± 8.6. During COT and NHF-OT, the AHI was 19.4 ± 7 and 5.4 ± 4.6, respectively (P < 0.001) and 19 patients reached an AHI < 5 during NHF-OT. The mean nocturnal SaO% was 86.2 ± 2.6 at baseline and at equivalent FiO it significantly increased to 91.8 ± 2.4 during COT and to 93.9 ± 2.5 during NHF-OT (P < 0.001). The T90% was 48.7 ± 20.1 at baseline, 16.8 ± 11.7 during COT, and 8.8 ± 8.0 during NHF-OT (P < 0.001).
In elderly patients with OS, nocturnal treatment with NHF-OT significantly reduces obstructive episodes and improves oxygenation. As the treatment is generally well tolerated compared to PAP, NHF-OT may be a possible alternative therapy in this subgroup of patients.
阻塞性睡眠呼吸暂停（OSA）和慢性阻塞性肺疾病（COPD）并存被称为“重叠综合征”（OS）。与单纯 OSA 患者相比，OS 患者通常年龄更大，在阻塞事件期间经历更严重的氧饱和度降低，常伴有持续的夜间通气不足。尽管富氧正压通气（PAP）是这些患者的首选治疗方法，但这种治疗方法往往难以耐受，尤其是对于老年人。本研究旨在评估通过鼻高流量（NHF-OT）进行夜间氧疗作为 PAP 的替代疗法在 OS 患者中的应用价值。
65 岁以上的 OS 合并夜间呼吸衰竭（SaO2<90%的时间（T90）>30%）患者进行心肺监测，在基线时、NHF-OT 期间或常规氧疗（COT）期间进行。
共有 40 名患者入组本研究。与基线和 COT 相比，NHF-OT 可显著降低所有患者的呼吸暂停低通气指数（AHI）。基础 AHI 平均值为 25.4±8.6。在 COT 和 NHF-OT 期间，AHI 分别为 19.4±7 和 5.4±4.6（P<0.001），19 名患者在 NHF-OT 期间 AHI<5。夜间 SaO2%平均值为基线时的 86.2±2.6，在等效 FiO2 时显著增加至 COT 时的 91.8±2.4 和 NHF-OT 时的 93.9±2.5（P<0.001）。T90%平均值为基线时的 48.7±20.1，COT 时的 16.8±11.7，NHF-OT 时的 8.8±8.0（P<0.001）。
在老年 OS 患者中，夜间使用 NHF-OT 治疗可显著减少阻塞性事件并改善氧合。由于与 PAP 相比，该治疗方法通常更耐受，因此 NHF-OT 可能是该亚组患者的一种替代治疗方法。
