合并OSAHS及严重程度对稳定期COPD患者左心功能及心血管事件发生风险的影响

摘要/Abstract

摘要： 目的探讨合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）及严重程度对稳定期慢性阻塞性肺疾病（COPD）患者左心舒张功能及心血管事件发生风险的影响。方法纳入2018年1月—2022年1月内蒙古自治区人民医院诊治稳定期COPD患者共272例,根据是否合并OSAHS分为合并组（200例）和未合并组（72例）,同时根据合并OSAHS严重程度分为轻度组（123例）、中度组（45例）及重度组（32例）;分析一般资料、心肺功能指标及预后指标;采用多元线性回归模型评价AHI与相关临床指标间的独立关系。结果合并组夜间平均血氧饱和度和最低血氧饱和度显著低于未合并组,差异有统计学意义（P<0.05）;合并组氧减指数、血氧饱和度≤90%时间占比及LVMI均显著高于未合并组,差异有统计学意义（P<0.05）;合并组OSAHS严重程度亚组之间E/e′、LAD、冠心病及充血性心力衰竭发生率比较,差异有统计学意义（P<0.05）;多元线性回归分析结果显示,在未校正任何因素、校正年龄和身体质量指数及校正年龄、性别、身体质量指数、充血性心力衰竭史、冠心病史、高血压史、肺心病史及吸烟情况三个模型中,以E/e′为因变量,AHI为自变量,合并OSAHS患者E/e′均随AHI水平增加而升高,差异有统计学意义（P<0.05）。结论稳定期COPD患者如合并OSAHS则左心功能损伤更为明显,心血管事件发生风险亦更高;同时OSAHS严重程度与左心功能损伤具有相关性。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 慢性阻塞性肺疾病, 稳定期, 心脏功能

Abstract: Objective To investigate the influence of complicated with OSAHS and OSAHS severity on left heart function and risk of cardiovascular events in COPD patients with stable stage. Methods 272 COPD patients with stable stage were retrospectively chosen in the period from January 2018 to January 2022 in our hospital. All patients were divided into the combined group (200 cases) and non-combined group (72 cases) according to combined with OSAHS or not, and mild group (123 cases), moderate group (45 cases) and severe group (32 cases) according to OSAHS severity. The general data, cardiopulmonary function indexes and prognostic indexes were analyzed. Multiple linear regression model was used to evaluate the independent relationship between AHI and related clinical indicators. Results The mean and minimum blood oxygen saturation at night in combined group were significantly lower than non-combined group（P<0.05）. The oxygen desaturation index, time proportion of blood oxygen saturation ≤90% and LVMI in combined group were significantly higher than those in non-combined group（P<0.05）. There were statistically significant differences in the incidence of E/e ', LAD, incidence of coronary heart disease and congestive heart failure among OSAHS severity subgroups（P<0.05）. Multiple linear regression analysis showed that E/ E 'was the dependent variable and AHI was the independent variable in the three models without adjusting for any factor, adjusted for age and BMI adjusted for age, sex, BMI, congestive heart failure history, history of coronary heart disease, history of hypertension, history of pulmonary heart disease and smoking status. E/e 'of patients with OSAHS higher with the increased of AHI level（P<0.05）. Conclusion The left heart function damage was more obvious and the risk of cardiovascular events was higher in stable stage COPD patients complicated with OSAHS and the severity of OSAHS was correlated with left heart function injury.

Key words: obstructive sleep apnea hypopnea syndrome, chronic obstructive pulmonary disease, stability, cardiac function

中图分类号:

韩佳丽. 合并OSAHS及严重程度对稳定期COPD患者左心功能及心血管事件发生风险的影响[J]. 中华养生保健, 2023, 41(23): 61-64.

HAN Jia-li. Influence of Complicated with OSAHS and OSAHS Severity on Left Heart Function and Risk of Cardiovascular Events in COPD Patients with Stable Stage[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(23): 61-64.

参考文献

[1] VOULGARIS A, ARCHONTOGEORGIS K, PATAKA A, et al.Burden of Comorbidities in Patients with OSAS and COPD-OSAS Overlap Syndrome[J]. FMedicina (Kaunas),2021,57(11):1201.
[2] LURIE A, ROCHE N.Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease: Facts and Perspectives[J]. COPD,2021,18(6):700-712.
[3] CHEN W, THOMAS J, SADATSAFAVI M, et al.Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis[J]. Lancet Respir Med,2015,3(8):631-639.
[4] KENDZERSKA T, LEUNG R S, AARON S D, et al.Cardiovascular Outcomes and All-Cause Mortality in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease (Overlap Syndrome)[J]. Ann Am Thorac Soc,2019,16(1):71-81.
[5] PELÀ G, LI CALZI M, PINELLI S, et al.Left ventricular structure and remodeling in patients with COPD[J]. Int J Chron Obstruct Pulmon Dis,2016,11(10):1015-1022.
[6] HU W, ZHAO Z, WU B, et al.Obstructive Sleep Apnea Increases the Prevalence of Hypertension in Patients with Chronic Obstructive Disease[J]. COPD,2020,17(5):523-532.
[7] NATTUSAMI L, HADDA V, KHILNANI G C, et al.Co-existing obstructive sleep apnea among patients with chronic obstructive pulmonary disease[J]. Lung India,2021,38(1):12-17.
[8] SWEED R A, HASSAN S, ELWAHAB N H A, et al. Comorbidities associated with obstructive sleep apnea: a retrospective Egyptian study on 244 patients[J]. Sleep Breath,2019,23(4):1079-1085.
[9] DIVO M, COTE C, DE TORRES J P, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med,2012,186(2):155-161.
[10] MARIN J M, SORIANO J B, CARRIZO S J, et al.Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome[J]. Am J Respir Crit Care Med,2010,182(3):325-331.
[11] 中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011 年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.
[12] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组,中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会.慢性阻塞性肺疾病诊治指南(2021年修订版)[J].中华结核和呼吸杂志,2021,44(3):170-205.
[13] 骆秀娟. 无创机械通气治疗COPD合并OSAHS重叠综合征患者的临床研究[J].全科医学临床与教育,2023,21(1):40-42.
[14] ZHANG P, CHEN B, LOU H, et al.Predictors and outcomes of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in China[J]. BMC Pulm Med,2022,22(1):16-21.
[15] JAOUDE P, EL-SOLH A A. Predictive factors for COPD exacerbations and mortality in patients with overlap syndrome[J]. Clin Respir J,2019,13(10):643-651.
[16] 方庆娟,李燕,李娜,等.慢性阻塞性肺疾病-阻塞性睡眠呼吸暂停低通气综合征重叠综合征患者认知功能障碍的相关因素分析[J].实用临床医药杂志,2022,26(19):55-60.
[17] VOULGARIS A, ARCHONTOGEORGIS K, PAPANAS N, et al.Increased risk for cardiovascular disease in patients with obstructive sleep apnoea syndrome-chronic obstructive pulmonary disease (overlap syndrome)[J]. Clin Respir J,2019,13(11):708-715.
[18] SIEBENMANN C, ROBACH P, LUNDBY C.Regulation of blood volume in lowlanders exposed to high altitude[J]. J Appl Physiol(1985),2017,123(4):957-966.
[19] 孙婉璐,黄永伟,张立强,等.慢性阻塞性肺疾病患者合并OSAHS对高碳酸血症的影响及其相关因素[J].中华健康管理学杂志,2023,17(5):331-336.
[20] PUNJABI N M, NEWMAN A B, YOUNG T B, et al.Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas[J]. Am J Respir Crit Care Med,2008,177(10):1150-1155.
[21] LINDBERG E, THEORELL-HAGLÖW J, SVENSSON M, et al. Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample[J]. Chest,2012,142(4):935-942.
[22] 王晶,陈曦,孙宁,等.COPD合并阻塞性睡眠呼吸暂停低通气综合征的临床分析[J].中华肺部疾病杂志(电子版),2022,15(6):819-821.
[23] 李艳华,袁开芬,曹丽娇,等.阻塞性睡眠呼吸暂停低通气综合征合并慢性阻塞性肺疾病患者的心肺功能、缺氧程度及炎症因子变化的临床意义[J].中国呼吸与危重监护杂志,2022,21(9):629-635.
[24] 赵建美,费玉玲,邵岩,等.阻塞性睡眠呼吸暂停低通气综合征合并COPD患者右心室收缩功能分析[J].国际呼吸杂志,2019,39(18):1397-1401.
[25] 赵守焱. 慢性阻塞性肺疾病稳定期患者合并阻塞性睡眠呼吸暂停低通气综合征与1年内急性加重次数的相关性[J].河北医药,2021,43(23):3611-3613,3617.
[26] 王欢欢,刘霖,高莹卉,等.老年阻塞性睡眠呼吸暂停低通气相关高血压患者颈动脉粥样硬化的影响因素[J].中华老年多器官疾病杂志,2022,21(6):413-419.
[27] 尹晓. 双水平气道正压通气治疗慢性阻塞性肺疾病合并阻塞性睡眠呼吸暂停低通气综合征的疗效及对肺功能的影响研究[J].中国医学文摘(耳鼻咽喉科学),2022,37(3):76-77.
[28] MAUFRAIS C, RUPP T, BOUZAT P, et al.Medex 2015: The key role of cardiac mechanics to maintain biventricular function at high altitude[J]. Exp Physiol,2019,104(5):667-676.
[29] 周钰皓,刘辉国.阻塞性睡眠呼吸暂停-慢性阻塞性肺疾病重叠综合征的研究进展[J].国际呼吸杂志,2021,41(4):309-314.
[30] ADLER D, BAILLY S, BENMERAD M, et al.Clinical presentation and comorbidities of obstructive sleep apnea-COPD overlap syndrome[J]. PLoS One,2020,15(7):e0235331.