摘要目的 探讨慢性阻塞性肺疾病(慢阻肺)合并阻塞性睡眠呼吸暂停(OSA)的临床特点,分析慢阻肺重叠OSA的危险因素.方法 前瞻性对431例慢阻肺患者进行多导睡眠监测,其中男388例,女43例,平均年龄(67±9)岁.根据监测结果,以AHI≤15次/h为慢阻肺组(151/431),其中男141例,女10例,平均年龄(67±9)岁;AHI>15次/h为合并OSA组(280/431),其中男247例,女33例,平均年龄(68±9)岁.比较两组的临床特点,采用单变量和多变量logistic回归分析慢阻肺合并OSA的危险因素.结果 两组患者在性别构成、呼吸困难量表评分、入组前1年急性加重次数、住院次数、合并冠心病、肺源性心脏病及糖尿病等差异均无统计学意义(均P>0.05).合并OSA组的年龄、体重指数[(24± 4)kg/m2]、颈围[38(36,40)cm]、吸烟指数[41(27,55)包年]、慢阻肺评估测试评分(CAT)[19(15,23)分]、FEV[11.4(0.9,2.0)L]、FEV1占预计值%[56(37,75)%]、FEV1/FVC[50(39,62)%]及合并高血压的比例(67/151)均高于慢阻肺组[(22±3)kg/m2、37(36,38)cm、40(25,55)包年、17(14,20)分、1.2(0.8, 1.6)L、46(30,62)%、41(30,52)%、40/280];病程[4(1,7)年]及重度慢阻肺比例(61/151)低于慢阻肺组[5(2,8)年、158/280,均P<0.05].合并OSA组Charlson合并症指数、Epworth嗜睡量表(ESS)评分、睡眠呼吸暂停临床评分(SACS)均高于慢阻肺组(均P<0.05).单因素分析结果显示,体重指数、颈围、ESS、SACS以及CAT评分均为慢阻肺合并OSA的危险因素,其中体重指数、ESS、CAT评分为慢阻肺合并OSA的独立危险因素.重度慢阻肺患者较轻、中度慢阻肺患者合并OSA的风险更低(β=-0.459,OR值为0.632,95% CI :0.401~0.997,P=0.048).结论 慢阻肺合并OSA患者的生活质量更差,日间嗜睡更明显,合并高血压更多;体重指数、ESS及CAT评分为慢阻肺合并OSA的独立危险因素;重度慢阻肺患者比轻、中度患者合并OSA的风险更低.

abstractsTo compare clinical characteristics between patients with chronic obstructive pulmonary disease (COPD) and COPD?OSA overlap, and to analyze the risk factors for OSA in patients with COPD. Methods A total of 431 patients with COPD were divided into a COPD?OSA group with AHI>15 events/h or a COPD group with AHI≤15 events/h according to the results of polysomnography, and their clinical characteristics were summarized. Risk factors for OSA overlap in COPD patients were identified by univariate and multivariate logistic regression analyses. Results There were no significant differences in gender composition, dyspnea scale (mMRC) score, the numbers of acute exacerbations and hospitalizations in the last year, prevalence of coronary heart disease, or cor pulmonale or diabetes mellitus in the two groups (all P>0.05). Age, BMI, neck circumference, smoking index, COPD assessment test (CAT) score, the values of FEV1 or FEV1%, FEV1/FVC ratios, and the prevalence of hypertension in the COPD?OSA group with AHI>15 events/h were significantly higher than in the COPD group with AHI≤15 events/h, while the duration of COPD and the proportion of severe COPD were lower than the COPD group with AHI≤15 (P<0.05). The scores of Charlson Comorbidity Index, Epworth Sleepiness Scale (ESS) and Sleep Apnea Clinical Score (SACS) in the COPD?OSA group were significantly higher than in the COPD group with AHI≤15, with all P values<0.05. Risk factors for AHI>15 OSA coinciding in patients with COPD included BMI, neck circumference, ESS, SACS and CAT (P<0.05). Furthermore, BMI, ESS and CAT were independent risk factors for OSA in COPD patients (P<0.05). Compared with mild or moderate COPD cases, patients with severe COPD (FEV1%<50%) had a lower risk of having OSA (β=-0.459, OR=0.632,95% CI 0.401-0.997, P=0.048). Conclusions Compared to COPD patients with AHI ≤ 15 events/h, OSA-COPD overlap patients (AHI>15 events/h) had a worse quality of life, more daytime sleepiness and higher prevalence of hypertension. BMI, ESS and CAT were independent risk factors for AHI>15 OSA in patients with COPD. The risk of having OSA in severe COPD patients was lower than cases with mild or moderate COPD.