重叠综合征患者肺动脉高压的临床和血液动力学特征。

The clinical and hemodynamic characteristics of pulmonary hypertension in patients with OSA-COPD overlap syndrome.

机构信息

Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China.

Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Am J Med Sci. 2024 Jun;367(6):375-381. doi: 10.1016/j.amjms.2024.03.014. Epub 2024 Mar 11.

DOI:10.1016/j.amjms.2024.03.014

PMID:38467374

Abstract

BACKGROUND

Our study aimed to assess the clinical and hemodynamic characteristics of pulmonary hypertension (PH) in patients with overlapping obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), referred to OSA-COPD overlap syndrome (OS).

METHODS

We enrolled a total of 116 patients with OS, COPD, or OSA who underwent right heart catheterization (RHC) due to suspected PH. We conducted a retrospective analysis of the clinical and hemodynamic characteristics of these patients.

RESULTS

Among the three groups (OS group, n = 26; COPD group, n = 36; OSA group, n = 54), the prevalence of PH was higher in the OS group (n = 17, 65.4%)compared to OSA group (n = 26,48.1%) and COPD group (n = 20,55.6 %). Among three groups with PH, the superior vena cava pressure (CVP) and right ventricular pressure (RAP) were higher in the OS group than in the OSA group (P < 0.05). Patients in the OS and COPD groups had higher pulmonary artery wedge pressure (PAWP) than in the OSA group (14.88 ± 4.79 mmHg, 13.45 ± 3.68 mmHg vs. 11.00 ± 3.51 mmHg, respectively, P < 0.05). OS patients with PH exhibited higher respiratory event index (REI), time spent with SpO <90%, oxygen desaturation index (ODI), minimal SpO (MinSpO) and mean SpO (MSpO) compared to OS patients without PH. After adjusting for potential covariates, we found that MinSpO (OR 0.937, 95 % CI 0.882-0.994, P = 0.032), MSpO (OR 0.805, 95% CI 0.682-0.949, P = 0.010), time spent with SpO <90% (OR 1.422, 95% CI 1.137-1.780, P = 0.002), and FEV1 % pred (OR 0.977, 95 % CI 0.962-0.993, P = 0.005) were related to the development of PH.

CONCLUSIONS

Patients with OS showed higher prevalence of PH, along with higher PAWP, CVP and RAP. Worse nocturnal hypoxemia was found in OS patients with PH.

摘要

背景

本研究旨在评估重叠性阻塞性睡眠呼吸暂停（OSA）和慢性阻塞性肺疾病（COPD）患者（即重叠性阻塞性睡眠呼吸暂停-慢性阻塞性肺疾病重叠综合征，OS）的肺动脉高压（PH）的临床和血液动力学特征。

方法

我们共纳入了 116 例因疑似 PH 而行右心导管检查（RHC）的 OSA、COPD 或 OSA 患者，对这些患者的临床和血液动力学特征进行了回顾性分析。

结果

在三组（OS 组，n = 26；COPD 组，n = 36；OSA 组，n = 54）中，OS 组的 PH 患病率（n = 17，65.4%）高于 OSA 组（n = 26，48.1%）和 COPD 组（n = 20，55.6%）。在三组 PH 患者中，OS 组的上腔静脉压（CVP）和右心房压（RAP）高于 OSA 组（P < 0.05）。OS 和 COPD 组患者的肺动脉楔压（PAWP）高于 OSA 组（分别为 14.88 ± 4.79 mmHg、13.45 ± 3.68 mmHg 比 11.00 ± 3.51 mmHg，P < 0.05）。与无 PH 的 OS 患者相比，有 PH 的 OS 患者的呼吸事件指数（REI）、SpO <90%的时间、氧减饱和度指数（ODI）、最小 SpO（MinSpO）和平均 SpO（MSpO）更高。在调整了潜在混杂因素后，我们发现 MinSpO（OR 0.937，95%CI 0.882-0.994，P = 0.032）、MSpO（OR 0.805，95%CI 0.682-0.949，P = 0.010）、SpO <90%的时间（OR 1.422，95%CI 1.137-1.780，P = 0.002）和 FEV1%预计值（OR 0.977，95%CI 0.962-0.993，P = 0.005）与 PH 的发生相关。