de Censo Caroline Maschio, Passini Viviane Vieira, Verri Bárbara Aparecida Teodoro Alcantara, Xavier Rafaella Fagundes, Carvalho-Pinto Regina Maria, Lorenzi-Filho Geraldo, Carvalho Celso R F
Departament of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Pulmonary Division, Heart Institute (InCor), Clinics Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
ERJ Open Res. 2024 Apr 15;10(2). doi: 10.1183/23120541.00948-2023. eCollection 2024 Mar.
The aim of this study was to assess the postural balance in COPD patients with obstructive sleep apnoea (OSA). Physical activity, anxiety and depression symptoms, mood, and falls were also assessed in this population.
Moderate to severe COPD patients were assessed for laboratory and clinical postural balance (force platform and mini-balance evaluation systems test (Mini-BESTest)), physical activity (accelerometry), OSA (polysomnography), sleep quality (Pittsburgh Sleep Quality Index), sleepiness (Epworth Sleepiness Scale), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), dyspnoea (modified Medical Research Council), clinical status (COPD Assessment Test) and mood (Brunel Mood Scale). Self-reported falls were recorded for 6 months phone calls.
COPD patients (n=70) were divided according to the polysomnography findings into the no OSA (n=30), mild OSA (n=25), and moderate to severe OSA (n=15) groups. Compared to patients with no OSA, those with moderate to severe OSA (msOSA group) presented median (interquartile range) increased path length (30.5 (23.9-34.5) cm 39.0 (30.6-52.6) cm, anteroposterior displacement (1.89 (1.39-2.31) cm 2.54 (2.06-2.83) cm and postural adjustment velocity (1.02 (0.80-1.15) cm·s 1.30 (1.02-1.76) cm·s) (p<0.05). No differences were observed in the Mini-BESTest scores among the groups. The msOSA group presented a greater number of recurrent fallers in the first follow-up trimester. No association was observed between postural balance and age and pulmonary function.
Individuals with COPD and moderate to severe OSA present changes in postural balance, including broader oscillation, faster postural adjustments and a greater risk of falls than those with no OSA. Physical activity, anxiety and depression symptoms, and mood are similar between COPD patients with and without OSA.
本研究旨在评估慢性阻塞性肺疾病（COPD）合并阻塞性睡眠呼吸暂停（OSA）患者的姿势平衡。同时还对该人群的身体活动、焦虑和抑郁症状、情绪及跌倒情况进行了评估。
对中重度COPD患者进行实验室及临床姿势平衡评估（测力平台和迷你平衡评估系统测试（Mini-BESTest））、身体活动评估（加速度计）、OSA评估（多导睡眠图）、睡眠质量评估（匹兹堡睡眠质量指数）、嗜睡评估（爱泼华嗜睡量表）、焦虑和抑郁症状评估（医院焦虑抑郁量表）、呼吸困难评估（改良医学研究委员会量表）、临床状态评估（COPD评估测试）及情绪评估（布鲁内尔情绪量表）。通过电话随访记录6个月内的自我报告跌倒情况。
根据多导睡眠图结果，将70例COPD患者分为无OSA组（n = 30）、轻度OSA组（n = 25）和中重度OSA组（n = 15）。与无OSA患者相比，中重度OSA患者（msOSA组）的中位（四分位间距）步长增加（30.5（23.9 - 34.5）cm对39.0（30.6 - 52.6）cm）、前后位移增加（1.89（1.39 - 2.31）cm对2.54（2.06 - 2.83）cm）以及姿势调整速度增加（1.02（0.80 - 1.15）cm·s对1.30（1.02 - 1.76）cm·s）（p < 0.05）。各组间Mini-BESTest评分未见差异。msOSA组在首次随访的三个月内反复跌倒的人数更多。姿势平衡与年龄及肺功能之间未观察到关联。
与无OSA的COPD患者相比，合并中重度OSA的COPD患者存在姿势平衡改变，包括摆动幅度更大、姿势调整更快以及跌倒风险更高。有或无OSA的COPD患者在身体活动、焦虑和抑郁症状及情绪方面相似。
