Fabozzi Antonio, Steffanina Alessia, Nicolai Ambra, Olmati Federica, Bonini Matteo, Palange Paolo
Pulmonology Unit, Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Roma, Italy.
J Clin Med. 2024 Oct 17;13(20):6189. doi: 10.3390/jcm13206189.
Obstructive sleep apnea (OSA) and obstructive lung diseases (OLD) are common and interdependent respiratory disorders, where one condition may contribute to the development and worsening of the other (OLDOSA syndrome). The term OLDOSA syndrome includes two different conditions: Overlap syndrome (OVS: OSA + chronic obstructive pulmonary disease, COPD) and Alternative Overlap syndrome (aOVS: OSA + Asthma). Data on the interactions between lung function and respiratory monitoring during sleep in OLDOSA patients are few and controversial. Our study aims to evaluate the impact of lung function impairment on sleep breathing disorders, paying attention to the lack of literature about comparisons between OVS, aOVS, and the impact of small airways disease (SAD) in these patients. In total, 101 patients with a diagnosis of OSA and asthma or COPD underwent pulmonary function tests (PFTs) and nocturnal home sleep cardiorespiratory monitoring (HSCM). Exclusion criteria: Obesity hypoventilation syndrome (OHS) and other non-respiratory sleep disorders. Sleep time with oxygen saturation below 90% (T90) was negatively correlated with forced expiratory volume in the first second, % of predicted (%FEV), forced vital capacity, % of predicted (%FVC), forced expiratory flow at 25-75% of the pulmonary volume, % of predicted (%FEF), and, after multivariable linear regression analysis, %FEF remained an independent factor for T90 with a negative correlation in mild and moderate OSA. Obstructive apnea index (oAI) and FEV/FVC were negatively correlated in mild and moderate OSA. OVS presented with more severe OSA (higher AHI, oAI, and T90) and SAD (lower FEF) compared to aOVS. This study highlights a possible interdependence between OLD and OSA; obstruction of the large and small airways at PFTs contributes to the worsening of these patients' nocturnal hypoxemia and obstructive events of the upper airway during sleep. Furthermore, this study shows that patients with OVS should be carefully monitored, as they present worse data at HSCM and have greater small airways involvement compared to aOVS.
阻塞性睡眠呼吸暂停（OSA）和阻塞性肺疾病（OLD）是常见且相互关联的呼吸系统疾病，其中一种疾病可能会促使另一种疾病的发生和恶化（OLD - OSA综合征）。术语OLD - OSA综合征包括两种不同情况：重叠综合征（OVS：OSA + 慢性阻塞性肺疾病，COPD）和交替重叠综合征（aOVS：OSA + 哮喘）。关于OLD - OSA患者睡眠期间肺功能与呼吸监测之间相互作用的数据很少且存在争议。我们的研究旨在评估肺功能损害对睡眠呼吸障碍的影响，同时关注缺乏关于OVS、aOVS之间比较以及这些患者中小气道疾病（SAD）影响的文献。总共101例诊断为OSA合并哮喘或COPD的患者接受了肺功能测试（PFT）和夜间家庭睡眠心肺监测（HSCM）。排除标准：肥胖低通气综合征（OHS）和其他非呼吸性睡眠障碍。氧饱和度低于90%的睡眠时间（T90）与第一秒用力呼气量、预测值百分比（%FEV）、用力肺活量、预测值百分比（%FVC）、肺容积25% - 75%时的用力呼气流量、预测值百分比（%FEF）呈负相关，并且在多变量线性回归分析后，%FEF仍然是T90的独立因素，在轻度和中度OSA中呈负相关。在轻度和中度OSA中，阻塞性呼吸暂停指数（oAI）与FEV/FVC呈负相关。与aOVS相比，OVS表现出更严重的OSA（更高的AHI、oAI和T90）和SAD（更低的FEF）。本研究强调了OLD和OSA之间可能存在的相互依存关系；肺功能测试时大气道和小气道的阻塞会导致这些患者夜间低氧血症恶化以及睡眠期间上气道阻塞事件增加。此外，本研究表明，与aOVS相比，OVS患者应受到密切监测，因为他们在HSCM中表现出更差的数据且小气道受累更严重。
