慢性阻塞性肺疾病-阻塞性睡眠呼吸暂停重叠综合征特点分析及康复疗效

目的:回顾性分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)-阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)重叠综合征的特点,探讨夜间无创通气和(或)有氧运动对其疗效。方法:对我院与复旦大学附属华东医院2016年1月至2018年12月196例稳定期COPD患者进行整夜多导睡眠图(polysomnography,PSG)监测,发现COPD-OSA重叠综合征70例。比较COPD与重叠综合征患者的睡眠参数、体质量指数(body mass index,BMI)、动脉血气分析、运动能力及呼吸困难程度的差异。对70例重叠综合征患者根据是否应用无创呼吸机并坚持治疗20周及以上分成联合干预组(27例)与有氧运动组(37例),分别给予无创通气和(或)有氧运动,比较干预前后及组间的睡眠参数、BMI、动脉血气分析、运动能力及呼吸困难程度的差异。结果:重叠综合征患者合并高血压(P<0.001)及冠心病(P=0.044)比例高于COPD患者,且在肺功能第1秒用力呼气量(forced expiratory volume in first second,FEV1)%预计值、6 min步行距离(6 minute walking distance,6MWD)、改良英国医学研究委员会呼吸困难量表(modified Medical Research Council Scale,mMRC)、BMI、睡眠参数呼吸暂停低通气指数(apnea-hypopnea index,AHI)、血氧饱和度<90%时间占监测总时间的百分比(TS90%)、最低脉搏氧饱和度(lowest pulse oxygen saturation,LSpO2%)]、动脉血气分析(pH、PO2、PCO2)均较COPD患者严重(P<0.05)。经过20周的无创通气和(或)有氧运动干预,联合干预组患者在AHI、TS90%、SpO2%、6MWD、pH、PO2均较有氧运动组改善(P<0.05),但在FEV1%预计值、BMI、mMRC、PCO2方面2组差异无统计学意义(均P>0.05)。结论:重叠综合征患者的睡眠参数、BMI、动脉血气分析、运动能力及呼吸困难程度均较COPD严重。无创通气联合有氧运动能明显改善重叠综合征患者的睡眠、BMI、动脉血气分析、运动能力及呼吸困难程度。

Characteristic analysis and rehabilitation efficacy of chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome

Objective Retrospective analysis of the characteristics of chronic obstructive pulmonary disease(COPD)-obstructive sleep apnea(OSA)overlap syndrome(OS),and evaluation of the therapeutic efficacy of noninvasive ventilation combined with aerobic exercise.Methods A total of 70 patients with OS were screened out of 196 patients with COPD by overnight polysomnography(PSG)monitoring.Parameters of PSG,body mass index(BMI),arterial blood gas analysis,exercise ability,and degree of dyspnea were compared between patients with COPD and OS.OS patients were placed treatment regimen with either combined intervention or aerobic exercise utilizing non-invasive ventilator for 20 weeks or longer.Results OS patients were more likely to have hypertension(P<0.001)and coronary heart disease(P=0.044)than COPD patients.Compared with COPD patients,the parameters such as forced expiratory volume in first second(FEV1),6-minute walking distance(6MWD),modified Medical Research Council Scale(mMRC),apnea-hypopnea index(AHI),the total recorded time spent below 90%oxygen saturation(TS90%),lowest pulse oxygen saturation(L-SpO2%)and arterial blood gas analysis deteriorated significantly in OS patients(P<0.05).After 20 weeks of noninvasive ventilation and/or aerobic exercise intervention,the parameters of patients receiving combined intervention,such as AHI,TS90%,L-SpO2%,6MWD,BMI,pH and PO2,improved significantly compared with patients taking aerobic exercise(P<0.05).But there were no difference of the parameters such as FEV1,mMRC and PCO2 between the two groups(P>0.05).Conclusions Clinical presentation is worse in patients with OS than COPD,as represented by poor sleep parameters,BMI,arterial blood gas analysis,motor ability and dyspnea.The noninvasive ventilation and aerobic exercise are the optimum management strategy for OS patients.