急性加重高风险慢性阻塞性肺疾病患者的睡眠质量及相关因素

目的调查急性加重高风险慢性阻塞性肺疾病（简称“慢阻肺”）患者的主、客观睡眠质量及其影响因素。方法回顾性收集26例急性加重高风险慢阻肺患者资料，患者于出院前1 d晚行整夜多导睡眠监测，记录患者肺功能、Epworth嗜睡评分（ESS）、匹兹堡睡眠质量问卷（PSQI）、英国医学研究委员会呼吸困难量表（mMRC）、慢阻肺患者自我评估测试（CAT）结果等临床信息。将PSQI评分＞5分定义为睡眠质量下降，根据睡眠监测结果将患者分为单纯慢阻肺组12例和重叠综合征组14例。入选同期睡眠室检查者27例，根据睡眠监测结果分为对照组13例和单纯阻塞性睡眠呼吸暂停低通气综合征（OSAHS）组14例。比较4组患者的主、客观睡眠参数并进行相关分析。结果26例急性加重高风险慢阻肺患者中23例存在睡眠质量下降。与对照组相比，单纯慢阻肺患者PSQI总分、ESS评分、觉醒次数、睡眠期总觉醒时间明显升高（P<0.05），总睡眠时间、客观睡眠效率明显低于对照组，差异有统计学意义（P<0.05）；重叠综合征组患者PSQI总分、客观睡眠潜伏期、觉醒次数明显高于OSAHS组（P<0.05）；与单纯慢阻肺组患者相比，重叠综合征患者慢波睡眠明显减少（P<0.05）。相关分析结果显示过去一年急性加重次数、呼吸困难指数、ESS评分与PSQI总分呈正相关；睡眠期总觉醒时间与CAT、mMRC评分呈正相关；快动眼睡眠占总睡眠时间百分比与FEF 25%～75%、PEF%呈正相关，慢波睡眠占总睡眠时间百分比与睡眠呼吸暂停低通气指数（AHI）呈负相关。结论慢阻肺急性加重高风险患者的主、客观睡眠质量均较差，重叠综合征患者睡眠质量较罹患单一疾病患者更差，PSQI与过去一年急性加重次数、呼吸困难指数、ESS评分相关，客观睡眠参数与气流阻塞程度、CAT评分、mMRC评分相关。

Sleep quality and related factors in patients with high-risk acute exacerbation of chronic obstructive pulmonary disease

ObjectiveTo investigate the subjective and objective sleep qualities and their influencing factors in patients with high-risk acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Patients with COPD hospitalized in the Department of Respiratory Medicine were screened out. All patients underwent overnight sleep monitoring within 1 day before being discharged. The clinical characters and spirometry results, Epworth Sleepiness Score (ESS), Pittsburgh Sleep Quality Index (PSQI), UK Medical Research Council Dyspnea Scale (mMRC), and COPD Asessment Test (CAT) results were recorded. PSQI score>5 was defined as reduced sleep quality. According to the results of sleep monitoring, the patients were divided into simple COPD group (n=12) and overlap syndrome group (n=14). Twenty-seven patients were selected for sleep room examination in our hospital. According to the results of sleep monitoring, they were divided into control group (n=13) and OSAHS group (n=14). The subjective and objective sleep parameters of the four groups were compared and the correlation analysis was carried out. ResultsSleep quality decreased in 23 of 26 patients with high-risk acute exacerbation of COPD. The total score of PSQI, the score of ESS, the number of awakening and wake time after sleep onset were significantly increased in patients with high-risk acute exacerbation of COPD; but the total sleep time (TST) and objective sleep efficiency were significantly lower than those in the control group. The total score of PSQI, objective sleep latency and awakening times in patients with overlap syndrome were significantly higher than those in OSAHS group (P<0.05), and compared with those in patients with high-risk acute exacerbation of COPD alone, the total score, objective sleep latency and awakening times in patients with overlap syndrome were significantly higher than those in patients with COPD alone. Slow wave sleep (SWS) was significantly reduced in patients with overlap syndrome (P<0.05). The results of correlation analysis showed that the times of acute exacerbation in the past year, dyspnea index and ESS score were positively correlated with the total score of PSQI; and the wake time after sleep onset was positively correlated with the scores of CAT and mMRC. The percentage of REM sleep to TST was positively correlated with FEF25%-75% and PEF%, while the percentage of SWS to TST was negatively correlated with AHI. ConclusionThe subjective and objective sleep qualities of patients with high-risk acute exacerbation of COPD are poor. The sleep quality of patients with overlap syndrome is worse than that of patients with a single disease. PSQI is correlated with the number of acute exacerbation, dyspnea index and ESS score in the past year. The objective sleep parameters are correlated with the degree of airflow obstruction, CAT score and mMRC score.