摘要目的:通过长期随访探讨无创正压通气（NIPPV）对慢性阻塞性肺疾病-阻塞性睡眠呼吸暂停重叠综合征（OVS）患者全因死亡的影响。方法:前瞻性纳入OVS患者187例，将之分为NIPPV组和未使用NIPPV组。其中NIPPV组92例，男85例，女7例，年龄47~80（66.5±8.5）岁；未使用NPPV组95例，男89例，女6例，年龄45~79（67.4±7.8）岁。自入组后开始随访，平均随访39（20，51）个月，比较两组患者的全因死亡。结果:两组患者基线资料比较差异无显著性（均 P>0.05），具有可比性。Kaplan-Meier曲线显示两组全因病死率无差异（log rank P=0.229），但未使用NIPPV组心脑血管疾病病死率更高（分别为15.8%、6.5%， P=0.045）。年龄、体重指数、颈围、PaCO 2、FEV 1、FEV 1占预计值%、中重度OSA（AHI>15次/h）、mMRC、CAT、慢阻肺急性加重次数及住院次数，与OVS患者发生死亡相关（ P<0.05）。其中，年龄（ HR为1.067，95% CI：1.017~1.119， P=0.008）、FEV 1（ HR为0.378，95% CI：0.176~0.811， P=0.013）以及慢阻肺急性加重次数（ HR为1.298，95% CI：1.102~1.530， P=0.002）是OVS患者死亡的独立危险因素。 结论:在常规治疗基础上加用NIPPV可降低OVS患者因心脑血管疾病而死亡的风险；OVS死亡患者的气流受限严重，而OSA程度相对较轻；高龄、低FEV 1以及慢阻肺急性加重次数是OVS患者死亡独立危险因素。

abstractsObjective:To investigate the effect of noninvasive positive pressure ventilation(NIPPV) on all-cause mortality in patients with chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome(OVS) through long-term follow-up.Methods:A total of 187 OVS patients were divided into the NIPPV group( n=92) and the non-NIPPV group( n=95). Of these, 85 males and 7 females were in the NIPPV group with an average age of (66.5±8.5) years(range 47-80 years); 89 males and 6 females were in the non-NIPPV group with an average age of (67.4±7.8) years(range 44-79 years). Follow-up was performed from enrolment with an average duration of 39(20, 51) months. The all-cause mortality was compared between the two groups. Result:There were no significant differences in their baseline clinical characteristics(all P>0.05), indicating that the data from the two groups were comparable. The Kaplan-Meier curve showed no difference in all-cause mortality between the two groups(log rank P=0.229). However, deaths from cardio-cerebrovascular diseases were higher in the non-NIPPV than in the NIPPV group(15.8% vs. 6.5%, P=0.045). Age, BMI, neck circumference, PaCO 2, FEV 1, FEV 1%, moderate to severe OSA(AHI>15 events/h), mMRC, CAT, number of acute exacerbations of COPD and number of hospitalizations were associated with all-cause death in OVS patients; among which, age( HR 1.067, 95% CI 1.017-1.119, P=0.008), FEV 1( HR 0.378, 95% CI 0.176-0.811, P=0.013), and number of COPD exacerbations( HR 1.298, 95% CI 1.102-1.530, P=0.002) were independent risk factors for all-cause mortality in OVS patients. Conclusions:The combination of NIPPV and conventional treatment may reduce cardio-cerebrovascular disease-related mortality in OVS patients. The deceased OVS patients had severe airflow limitation and mild to moderate OSA. Old age, low FEV 1 and COPD exacerbations were independent risk factors for all-cause mortality in OVS patients.