伴与不伴睡眠呼吸暂停综合征的COPD患者肺功能与低氧血症的关系

目的探讨慢性阻塞性肺疾病（COPD）伴与不伴睡眠呼吸暂停综合征（SAHS）患者夜间低氧与肺功能的关系。方法对140例稳定期COPD患者进行肺通气功能测定和家庭夜间血氧饱和度监测。用Spearman相关系数来对肺功能与最低血氧饱和度（LSaO2），平均血氧饱和度（MSaO2）、SaO2低于90％时间占总睡眠时间百分比（SIT 90％）进行相关分析。结果相关分析表明夜间最低血氧饱和度与体重指数（BMI）呈负相关（r=-0．25，P〈0．05）、与FVC占预计值％（FVC％）、残气容积（RV）（r值分别为0．26、0．25，P均〈0．05）呈正相关，夜间平均血氧饱和度（MSaO2）与峰流量（PEF）、FVC％、FEV1占预计值％（FEV1％）、最大呼气中段流量（MMEF）呈正相关（r值分别为0．21、0．27、0．25、0．22，P均〈0．01），与RV呈负相关（r=-0．32，P〈0．01），SIT90％与RV呈正相关（r=0．22，P〈0．05）、与PEF、FVC、FVC％、FEV1、FEV1％呈负相关（r值分别为-0．29、-0．21，P均〈0．05）。阻塞程度相同的重叠综合征与单纯COPD患者在FEV1％，PEF％，RV％，TLC％，BMI，SIT90％，LSaO2等方面比较差异有统计学意义。结论COPD患者夜间低氧与COPD肺功能分级相关。伴SAHS的COPD患者（重叠综合征）夜间低氧比单纯COPD患者更严重。

Relationship between pulmonary function and nocturnal desaturation in COPD patients with and without Sleep-Apnea Hypopnea Syndrome

Objective To Study the relationship of pulmonary Function and nocturnal desaturation in COPD patients with and without SAHS. Methods 140 patients with stable COPD were under home pulse oximeter testing and Respiratory function testing, From Overnight Pulse Oximetry, the percentage of time spent at SaO2 below 90% （ SIT 90% ）, mean SaO2 （ MSaO2 % ）, the lowest SaO2 （ LSaO2 % ） and the number of desaturations≥4% per hour（ODI4） were calculated, all patients performed spirometry. Result In Pearson correlation analysis, the lowest nocturnal oxygen saturation（ LSaO2 ）correlatedwithBMI, FVC% Pred,RV （ r = - 0. 25, 0. 26, 0. 25, all P 〈 0. 05 ）, MeanSaO2 （ MSaO2 % ） correlatedwithPEF, FVC%, FEV1 % ,MMEF,RV（r =0.21,0.27,0.25,0.22 ,all P 〈0.05） ,SIT 90% correlated with RV（r =0.22 ,P 〈 0.05）. We found that there are significant difference on FEV1% ,PEF% ,RV% ,TLC% ,BMI,SIT9,LSaO2 between COPD alone and overlap syndrome. Conclusion The degree of nocturnal desaturation in COPD patients correlated with pulmonary Function criteria of COPD. Patients with overlap have a more important sleep-related O2 desaturation than do patients with COPD with the same degree of bronchial obstruction.