睡眠重叠综合征患者发生肺动脉高压的相关因素调查

目的 调查睡眠重叠综合征（overlap syndrome，OS）患者肺动脉高压（pulmonary hypertension，PH）发病的独立相关因素。方法 调查2019年1月至2020年1月在首都医科大学附属北京安贞医院呼吸与危重症医学科就诊的128名患者。检测肺功能诊断慢性阻塞性肺疾病（以下简称慢阻肺）；采用睡眠监测识别睡眠呼吸事件且呼吸暂停低通气指数（apnea-hypopnea index，AHI）≥ 5次/h的患者诊断阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）。同时符合慢阻肺和OSA的患者诊断为OS。校正年龄、性别和体质量指数后，使用多元逐步Logistic回归模型分析PH发病的独立相关因素。结果 与单纯OSA和单纯慢阻肺患者相比，OS患者最低血氧饱和度（79% vs 82%和90%，P<0.001）和平均血氧饱和度（92% vs 93%和95%，P<0.001）显著偏低；睡眠血氧饱和度低于90%所占整夜睡眠百分比（11% vs 6%和0%，P<0.001）显著偏高。第一秒用力肺活量（forced expiratory volume in the first second，FEV₁）低于80%预计值的患者发生PH概率是对照患者的2.78倍（OR 2.78，95%CI 1.05~7.38，P=0.040），AHI ≥ 15次/h的患者PH发生的概率是AHI<15次/h患者的3.46倍（OR 3.46，95%CI 1.02~11.71，P=0.046）。校正年龄、性别和体质量指数等混杂因素后，FEV₁ <80%预计值的患者发生PH概率是对照患者的3.57倍（OR 3.57，95%CI 1.20~10.62，P=0.022）。结论 肺通气功能下降是OS患者发生PH的独立相关因素。需要进一步研究气道正压通气等干预能否降低PH的严重程度并改善患者的长期预后。

Factors associated with the prevalence of pulmonary hypertension in patients with sleep overlap syndrome

Objective To elucidate the independent correlative factors for polysomnography and spirometry related to pulmonary hypertension (PH) among patients with sleep overlap syndrome (OS). Methods Totally 128 subjects were recruited in the Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University from January 2019 to January 2020. Spirometry and full-night sleep test were carried out to identify chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). OSA was identified if an apnea-hypopnea index(AHI) was higher than 5 events/hour. OS was diagnosed when patients met both criteria of COPD and OSA. Independent correlative factors for the prevalence of PH were surveyed by multiple stepwise Logistic regression with age, sex and body mass index adjusted for. Results Compared with subjects with isolated OSA and COPD, the patients with OS had lower nadir nocturnal saturation (82% and 90% vs 79%, P<0.001) and average nocturnal saturation (93% and 95% vs 92%, P<0.001), but higher percentage of total sleep time with saturation <90% (6% and 0% vs 11%, P<0.001). The PH prevalence in the patients with forced expiratory volume <80% predicted value in the first second (FEV₁) was 2.78 times higher than that in the patients with FEV₁ ≥ 80% predicted value (OR 2.78, 95%CI 1.05-7.38, P=0.040). The PH prevalence was higher in the patients with AHI ≥ 15 events/h than those with AHI <15 events/h (OR 3.46, 95%CI 1.02-11.71, P=0.046). After adjusting for confounding variables, the PH prevalence was 3.57 higher in the patients with FEV₁<80% predicted value than those with FEV₁ ≥ 80% predicted value (OR 3.57, 95%CI 1.20-10.62, P=0.022). Conclusion Pulmonary ventilatory defect is independently associated with the prevalence of PH. Further studies are needed to investigate whether effective interventions may alleviate PH prevalence and thus improve long term prognosis in the patients with OS.