慢性阻塞性肺疾病患者睡眠呼吸紊乱类型及其与呼吸中枢反应性的关系

目的分析重叠综合征慢性阻塞性肺疾病（COPD）合并睡眠呼吸暂停低通气综合征（SAHS）]患者睡眠呼吸紊乱的特点，并探讨其与呼吸中枢反应性的关系。方法对300例稳定期COPD患者经问卷、Epworth嗜睡量表及家庭血氧饱和度监测，对氧减饱和指数〉5次／h或嗜睡评分≥10分的患者进行多导生理记录仪睡眠呼吸监测，其中呼吸暂停低通气指数（AHI）≥10次／h的患者有79例（重叠综合征组）。选择年龄、性别及体重指数与其相匹配的118例单纯SAHS患者（SAHS组），对比分析其睡眠呼吸紊乱的特点。另外测定重叠综合征组22例患者的呼吸中枢高CO2反应性和低氧反应性，并与300例COPD患者中17例和SAILS组中17例的相应检测结果进行比较。结果40％（32／79）的重叠综合征患者在睡眠过程中出现延续时间〉1min的持续肺泡通气不足，但单纯SAHS患者此种现象很少见。重叠综合征组的低通气指数占AHI百分比（69±30）％]、总低通气时间占总睡眠时间百分比（15±12）％]均较单纯SAHS组（52±31）％、（12±10）％]明显增高。重叠综合征患者在清醒状态下的△呼气流量／△动脉血氧饱和度（-0．11±0．05）L·min^-1·％^-1]和△呼气流量／△动脉血二氧化碳分压（1．1±0．8）L·min^-1·mmHg^-1（1mmHg=0．133kPa）]均明显低于单纯SAHS患者（-0．35±0．24）L·min^-1·％^-1和（1．6±0．8）L·min^-1·mmHg^-1]。结论重叠综合征患者的睡眠呼吸紊乱模式以低通气为主，其清醒时呼吸中枢的低氧反应性降低。

Respiration control dysfunction and the relationship to sleep-disordered breathing in patients with chronic obstructive pulmonary disease

OBJECTIVE: To analyze the polysomnographic (PSG) features of sleep apnea hypopnea syndrome (SAHS) in patients with chronic obstructive pulmonary disease (COPD), and to define the association between SAHS and respiratory control disorder. METHODS: Three hundred patients with stable COPD were screened for SAHS using questionnaire, Epworth sleep scale (ESS) and home pulse oximeter testing. Those with ESS > or = 10 or oxygen desaturation over 3% more than 5 times per hour sleep were under further PSG testing. The PSG features were compared between COPD patients with apnea hypopnea index (AHI) > 10 and 118 SAHS patients with normal lung function. The two groups were matched for age, body mass index (BMI) and AHI. Among them 22 with COPD and AHI > or = 10 were tested for the chemo-responsiveness to isocapnic hypoxia and hypercapnia. RESULTS: Among the 300 patients with stable COPD, 79 had AHI over 10, meeting the diagnostic criteria of overlap syndrome (OS). Analysis of the polysomnography found that 32 cases (40%) with OS had more hypoventilation lasting over 1 min during sleep. Compared to patients with SAHS only, OS patients had higher percentage of hypopnea index over AHI (69 +/- 30)% vs (52 +/- 31)%] and a higher percentage of total hypopnea time over total time of sleep apnea and hypopnea (15 +/- 12)% vs (12 +/- 10)%]. OS patients also had lower hypoxic (-0.11 +/- 0.05) vs (-0.35 +/- 0.24) L.min(-1).%(-1)] and hypercapnic responses (1.1 +/- 0.8) vs (1.6 +/- 0.8) L.min(-1).mm Hg(-1) (1 mm Hg = 0.133 kPa)]. CONCLUSION: Patients with both COPD and SAHS had more episodes of hyponea and hypoventilation during sleep, and had depressed chemo-responsiveness to hypoxia during wakefulness.