重叠综合征

慢性阻塞性肺疾病（COPD）是一种以气流受限不完全可逆为特征的常见的慢性呼吸系统疾病。睡眠呼吸暂停低通气综合征（SAHS）也是一种具有潜在危险的常见病。故COPD与SAHS合并存在者即重叠综合征患者的概率相当高。COPD患者睡眠时显著的低氧血症和高碳酸血症发生于快动眼睡眠期。重叠综合征患者较单纯SAHS或COPD患者有更为严重的睡眠有关的低氧血症,表现出更为严重的肺功能损害和肺动脉高压。因此,重叠综合征患者的及时诊断和合理治疗具有重要临床意义。     

阻塞性睡眠呼吸暂停低通气综合征合并慢性阻塞性肺疾病的重叠综合征临床特点

目的 探讨重叠综合征（OS）患者的临床特征,为OS的诊断和治疗提供参考.方法 选取96例阻塞性睡眠呼吸暂停低通气综合征（OSAHS）、36例慢性阻塞性肺疾病（COPD）、32例OS患者以及13例正常对照者,询问其Epworth嗜睡评分（ESS）、高血压病史,测定其颈围,计算BMI,所有患者均行多导睡眠监测、肺功能和动脉血气测定,记录呼吸暂停低通气指数（AHI）、最长呼吸暂停时间（LAT）、夜间最低氧饱和度（LSaO2）、夜间平均氧饱和度（MSaO2）、血氧饱和度＜90％时间占监测总时间的百分比（Ts90％）、慢波睡眠（Ⅲ期睡眠）及快速眼动相睡眠（REM）占总睡眠百分比、微觉醒指数、夜间心律失常发生率,第一秒用力呼气容积（FEV1）占预计值百分比、FEV1/用力肺活量（FVC）、PaO2和PaCO2等指标,并对相应结果进行统计分析.结果 OS组和OSAHS组患者的BMI、颈围显著高于COPD组和对照组.OS组患者ESS、AHI、PaCO2等数值明显高于COPD组、OSAHS组和对照组,而夜间最低血氧饱和度、平均氧饱和度、FEV1％和FEV1/FVC等则明显低于其他3组（P＜0.05）.结论 OSAHS伴有肥胖者COPD患者更易患OS.OS患者夜间低氧血症、睡眠质量、肺功能减退程度以及日间低氧血症和高碳酸血症较单纯COPD或OSAHS更严重.应提高对OS的认识.     

重叠综合征36例临床分析

目的提高对重叠综合征(COPD合并OSAS)的临床认识。方法回顾性的分析了36例重叠综合征的临床资料,36例都有慢性阻塞性肺疾病(COPD)的病史,所有患者均进行睡眠检查(澳大利亚产的AutoSet),符合阻塞性睡眠呼吸暂停综合征(OSAS)的诊断标准。结果重叠综合征患者既有COPD的临床表现,又有OSAS的症状和体征,其比单纯OSAS/COPD有更严重的与睡眠有关的低氧,更易引起肺动脉高压及发展成慢性肺心病。结论COPD患者如有OSAS的症状和体征,如打鼾、夜间呼吸暂停及白天嗜睡等临床表现,应及时行睡眠监测。临床上可用无创伤性正压通气治疗改善患者睡眠质量并纠正夜间低氧血症。     

重叠综合征111例临床分析

目的探讨重叠综合征的诊断、治疗。方法对111例慢性阻塞性肺病（COPD）合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的患者进行分析。结果111例重叠综合征患者中,易患因素有高龄男性、肥胖、吸烟、饮酒,平均基础SaO2为87．76％,平均夜间最低SaO2为69．68％,平均SaO2〈90％的时间为382min,氧减次数为274次。结论慢性阻塞性肺病常伴阻塞性睡眠呼吸暂停低通气综合征,COPD患者中对高龄男性、肥胖、吸烟、饮酒等因素者,应常规进行多导睡眠呼吸监测,以确诊是否伴有OSAHS。已确诊为重叠综合征的患者,应给予CPAP或BiPAP呼吸机治疗,同时配合吸氧。     

重叠综合征23例临床分析

目的 探讨重叠综合征(overlap-syndrome,OS)患者的临床特点以及双水平气道正压(hi-level positive airway pressure,BiPAP)通气呼吸机对OS患者的临床疗效.方法 对23例OS患者及同期入院的23例单纯阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的体质量指数(BMI),睡眠呼吸暂停低通气指数(AHI),夜间最低血氧饱和度(LSaO_2)及并发症行网顾性对比分析.并对23例OS患者应用呼吸机BiPAP模式治疗,行疗效观察,观察治疗前后多导睡眠监测数据,动脉血气分析及肺功能结果.结果 两组患者的BMI,夜间LSaO_2等指标比较差异有统计学意义(P<0.05),OS患者合并冠状动脉粥样硬化性心脏病.呼吸衰竭的发生率较单纯OSAHS患者更高.应用BiPAP呼吸机治疗23例OS患者疗效显著,治疗前后AHI夜间LSaO_2,氧饱和度低于90%占整夜总睡眠时间的百分比,动脉血气,肺功能均有显著的改善.结论 OS患者有显著的临床特点,并发症多且严重.呼吸机BiPAP模式治疗能显著改善患者的临床症状及相关指标,疗效确切,是一种理想的治疗方法.     

重叠综合征与炎症、心血管疾病关系的研究进展

<正>阻塞性睡眠呼吸暂停低通气综合征(OSAHS)和慢性阻塞性肺疾病(COPD)都是呼吸系统的常见病、多发病,且常同时存在,也就是常说的重叠综合征(OS)。OSAHS和COPD都是肺动脉高压、肺源性心脏病、心力衰竭、呼吸衰竭及脑卒中等心脑血管疾病的高危人群及独立危险因素〔1〕,而OS因为同时存在上气道和下气道的阻塞及呼吸运动减弱,将引起更严重的低氧,使心血管疾病的发生出现更早更严重,从而导致预后更差,     

中老年阻塞性睡眠呼吸暂停低通气综合征患者血清chemerin水平的变化

目的研究血清chemerin在轻中度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中水平变化、影响因素及意义。方法选取经多导睡眠图(PSG)监测新诊断的病例组(包括轻度OSAHS组28例、中度OSAHS组23例)、对照组(体检健康者)30例。记录睡眠呼吸暂停低通气指数(AHI)、最低脉搏氧饱和度(LSpO_2),测定体质指数(BMI)、空腹血糖(FPG)及血清chemerin水平。结果轻度OSAHS组血清chemerin、降钙素原(PCT)水平均显著高于对照组(P<0.05);中度OSAHS组chemerin水平显著高于轻度组(P<0.05)。简单线性相关提示:chemerin与BMI、FPG、AHI呈正相关(分别r=0.272、0.820、0.837,均P<0.05),与LSp O2呈负相关(r=-0.702,P<0.05);多重线性相关分析提示AHI、BMI是血清chemerin的影响因素。结论 chemerin或可作为OSAHS病情严重程度的全新评价指标。     

肿瘤坏死因子-α在OSAHS-COPD重叠综合症及OSAHS中的血清水平研究

目的 探讨OSAHS及OSAHS—COPD重叠综合症患者肿瘤坏死因子-α的血清水平和经过经鼻持续气道正压通气治疗的影响。方法 采用双抗体夹心酶联免疫吸附法（EUSA）测定阻塞性睡眠呼吸暂停-低通气综合症组20例、重叠综合症组20例和健康对照组20例的血清肿瘤坏死因子-α水平。OSAHS组及OSAHS—COPD重叠综合症均经1个月持续气道正压通气（nCPAP）治疗一个月,然后复查血清肿瘤坏死因子-α。结果：OSAHS组及OSAHS—COPD重叠综合症组患者血清肿瘤坏死因子-α水平较健康对照组明显升高（P〈0．001）。经鼻持续气道正压通气（nCPAP）显著地降低了OSAHS组及OSAHS—COPD重叠综合症组血清肿瘤坏死因子-α水平。但OSAHS组及OSAHS—COPD重叠综合症组血清肿瘤坏死因子-α水平相比较无论治疗前后均无明显统计学差异。结论 血清肿瘤坏死因子-α水平在OSAHS组及OSAHS—COPD重叠综合症组患者中明显升高,经过经鼻气道正压通气治疗后下降。OSAHS组及OSAHS—COPD重叠综合症组无论治疗前、后比较均无明显统计学差异。     

重叠综合征-慢性阻塞性肺疾病合并睡眠呼吸暂停低通气综合征

慢性阻塞性肺疾病和睡眠呼吸暂停低通气综合征都属于常见病,两者并存称为重叠综合征,估计40岁以上的人群中患病率为0.5%左右.本文就慢性阻塞性肺疾病和睡眠呼吸暂停低通气综合征的关系、重叠综合征的临床表现及治疗原则作一综述.     

诱导痰细胞分类在重叠综合征患者中的表达

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并慢性阻塞性肺疾病(COPD)的重叠综合征(OS)患者气道炎症反应情况。方法入选49例受试者分成3组,OS组18例、COPD组15例、OSAHS组16例,另设20例正常对照组,分别完成体质量指数(BMI)测定、肺功能检查、多导睡眠图(PSG)监测、诱导痰细胞分类检测等,并比较4组水平的差异。结果 OS组与OSAHS组的BMI高于正常对照组和COPD组,差异有统计学意义(P<0.05);OS组与OSAHS组的呼吸暂停低通气指数(AHI)明显高于正常对照组和COPD组,差异有统计学意义(P<0.05);OS组和COPD组的FEV_1%pred明显低于正常对照组和OSAHS组,差异有统计学意义(P<0.05);OS组的动脉血氧分压(PaO_2)明显低于其他3组水平,差异有统计学意义(P<0.05)。OS组的嗜中性粒细胞百分比明显高于其他3组,差异均有统计学意义(P<0.05);OSAHS组与COPD组的嗜中性粒细胞百分比都明显高于正常对照组,差异均有统计学意义(P<0.05)。49例受试者嗜中性粒细胞相对计数水平与PaO_2呈低度负相关(r=-0.22,P<0.05),与FEV_1%pred呈中度负相关(r=-0.48,P<0.05)。结论 OS患者气道炎症反应更加强烈,易引起更为严重的通气功能障碍,间歇性低氧血症更为明显。诱导痰细胞分类计数检测有助于反映OS患者气道炎症病变情况。     

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文章介绍了重叠综合征的定义、流行病学现状、主要临床特征、诊断方法思路及治疗方法,重点比较重叠综合征与单纯慢性阻塞性肺疾病(COPD)及睡眠呼吸暂停低通气综合征临床表现的异同,有助于加强对重叠综合征的认识。     

Hypercapnia in Overlap Syndrome: Possible Determinant Factors

We retrospectively evaluated data from 213 consecutive patients; 152 were affected by obstructive sleep apnea (OSA), 29 had OSA associated with chronic obstructive pulmonary disease (COPD), also known as overlap syndrome, and 32 had COPD. Patients with obesity-hypoventilation syndrome were not included. The aims of the study were to evaluate the anthropometric, pulmonary, and polysomnographic characteristics of patients affected by overlap syndrome compared to simple OSA and to COPD subjects and to analyze the determinants of hypercapnia in overlap syndrome. In the comparison between overlap and OSA patients, the overlap group had a significantly higher PaCO₂ (44.59 vs. 39.22 mm Hg; p < 0.01), in the presence of a similar AHI (40.46 vs. 41.59/h). Comparing overlap to COPD patients, overlap showed a significantly higher PaCO₂ value (44.59 vs. 39.63 mm Hg; p < 0.005) and had significantly less severe obstructive impairment (FEV 162.93 vs. 47.31%; FEV₁/FVC ratio 66.71 vs. 59.25%; p < 0.005). Anthropometric, pulmonary function, and polysomnographic data did not differ between normo- and hypercapnic overlap patients. The best model (stepwise multiple regression analysis) for predicting PaCO₂ in overlap patients showed r2 value 0.65: PaO₂ contributed to 38%, FEV₁ to 15%, and weight to 12%. In conclusion, the occurrence of hypercapnia in overlap patients is only partially explained by the combination of overweight and reduced respiratory function, supporting the hypothesis of a multifactorial genesis.     

COPD合并阻塞性睡眠呼吸低通气综合症的临床研究

目的研究慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸低通气综合症(O SAHS)对肺功能、血氧饱和度(SaO2)、肺动脉压力的影响。方法对24例COPD和18例重叠综合征患者的肺功能、血氧饱和度、睡眠呼吸暂停低通气指数(AH I)、体重指数(BM I)进行比较。结果重叠综合征组与COPD组的夜间最低SaO2有显著性差异(P<0.05),AH I有显著性差异(P<0.01)。结论重叠综合征夜间缺氧往往比单纯的COPD更为明显。应该早诊断,早治疗,减少并发症。     

Medical Utilization and Cost in Patients with Overlap Syndrome of Chronic Obstructive Pulmonary Disease and Asthma

Background: Little information is available regarding medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease (COPD) and asthma. The purpose of this study is to analyze medical utilization and cost in patients with overlap syndrome and to compare them to COPD patients without asthma. Methods: Using the 2009 Korean National Health Insurance (NHI) database, COPD patients were identified. Medical utilization and costs were also analyzed. Results: Of a total of 185,147 patients identified with COPD, 101,004 patients were classified with overlap syndrome of COPD and asthma and 84,143 patients with COPD without asthma. In 2009, the percentages of emergency room visits, admissions, and intensive care unit admissions were 14.6%, 30.5%, and 0.5%, respectively, in the patients with overlap syndrome group and 5.0%, 14.1%, and 0.2%, respectively, in the COPD patients without asthma group (p < 0.05 for all comparisons). The cost of medical utilization was 790 ± 71 US dollars per person and 3,373 ± 4,628 dollars per person for outpatient and inpatient services, respectively, in the patients with overlap syndrome and 413 ± 512 and 3,010 ± 5,013, respectively, in the COPD patients without asthma (p < 0.05 for all comparisons). Multiple linear regression showed that age, sex, overlap syndrome, hospitalization in the last year, low socioeconomic status, and type of hospital use were significant factors affecting medical utilization and cost. Conclusions: In patients with overlap syndrome, both medical utilization and cost were higher than in COPD patients without asthma.     

慢性阻塞性肺疾病和OSAHS重叠综合症27例临床分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征对慢性阻塞性肺疾病患者的影响。方法分析82例慢性阻塞性肺疾病患者和27例重叠综合征(慢性阻塞性肺疾病及阻塞性睡眠呼吸暂停低通气综合征重叠)患者的临床资料,比较其1秒钟用力呼气量,多导睡眠图监测中最低血氧饱和度,血氧饱和度低于90%占监测总时间的百分比,日间最低血氧饱和度,发生Ⅱ呼吸衰竭的例数,合并肝肾功能异常、高血压、糖尿病或心脑血管病得例数,死亡率。结果重叠综合征患者的日间、夜间最低血氧饱和度、血氧饱和度低于90%占监测总时间的百分比、发生Ⅱ呼吸衰竭的比例,并发肝肾功能异常、高血压、糖尿病或心脑血管病的比例及死亡率均显著高于慢性阻塞性肺疾病患者(P0.05)。结论及时发现慢性阻塞性肺疾病患者中是否合并阻塞性睡眠呼吸暂停低通气综合征的存在非常重要。     

Lack of Benefit of Continuous Positive Airway Pressure on Lung Function in Patients with Overlap Syndrome

Obstructive sleep apnea (OSA) has been shown to be an inflammatory stimulus and may potentially result in a deterioration in the respiratory status of patients with coexistent chronic obstructive pulmonary disease (COPD) (overlap syndrome). We hypothesized that with treatment of OSA, there would be an improvement in coexistent COPD in overlap patients. We also sought to characterize overlap patients by comparing them with patients with either OSA or COPD alone. We performed a retrospective study of patients who attended a university-affiliated Veterans Affairs hospital. Demographic and clinical data were obtained from the medical charts and pharmacy records for the preceding two years and for the two years following the initiation of continuous positive airway pressure (CPAP) therapy. Overlap patients had moderately severe sleep apnea (AHI 28.6 ± 4.2) and moderately severe COPD (FEV₁= 1.94 ± 0.10 L). The prevalence of overlap syndrome in COPD patients was 11.9%, and 41% in OSA patients. Overlap patients who were compliant with CPAP therapy experienced a greater decrease in FEV₁, percent predicted FEV₁, percent decrease in FEV₁, FVC, percent predicted FVC, and percent decrease in FVC when compared with noncompliant patients. A very strong correlation was found between the average hours of CPAP use per day and the percent decrease in FEV₁ (r = 0.69, p = 0.003). There was a similar strong correlation for the decrease in FEV₁ and percent predicted FEV₁. OSA is common in COPD patients; similarly, COPD is common in OSA patients. Treatment of OSA with CPAP therapy in patients with overlap syndrome may not lead to an improvement in the coexistent COPD.     

阻塞性睡眠呼吸暂停综合征与慢性阻塞性肺疾病的相关分析

目的观察阻塞性睡眠呼吸暂停综合征（OSAS）与慢性阻塞性肺疾病（COPD）是否具有相关性。对50例OSAS患者依是否伴发COPD分为单纯OSAS组和重叠综合征组,分别对其肺功能和睡眠呼吸多导分析资料进性分析。50例中30例为重叠综合征,其夜间与睡眠有关的低氧血症较单纯OSAS患者更为明显。     

老年重叠综合征患者肺动脉高压临床分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并慢性阻塞性肺病（COPD）,即重叠综合征（OS）与肺动脉高压的关系。方法回顾性分析2000年1月至2009年1月北京世纪坛医院老年医学科门诊及住院,经过完整的肺功能、动脉血气分析、超声心动图及夜间多导睡眠监测的60岁以上患者89例。结果 OSAHS组与OS组之间性别比例、年龄及体质量指数（BMI）均无显著差异（P〉0.05）。超声心动图检查结果提示：5例（5/53,9%）OSAHS患者、23例（23/36,67%）OS患者存在肺动脉高压;多导睡眠监测结果提示,OSAHS组与OS组患者夜间均存在明显低氧血症,表现为夜间最低血氧饱和度的降低及氧减指数的增加,但以OS组患者更为显著;日问的动脉血气分析结果提示,与OSAHS患者比较,OS组患者日间氧饱和度（SaO_2）、动脉氧分压（PaO_2）降低、二氧化碳分压（PaCO_2）增高。结论相对于OSAHS患者,OS患者发展为肺动脉高压和Ⅱ型呼吸衰竭的风险更高。