Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors
Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors
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DOI：
10.1183/09031936.03.00066802
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发表时间：
2003-06-01
影响因子：
24.3
通讯作者：
McEvoy, RD
中科院分区：
文献类型：
--
作者：
O'Donoghue, FJ;Catcheside, PG;McEvoy, RD
睡眠低通气（SH）可能在慢性阻塞性肺疾病（CORD）高碳酸血症性呼吸衰竭的发生中起重要作用。对54例无睡眠呼吸暂停或病态肥胖的稳定期高碳酸血症COPD患者进行SH患病率、相关因素和夜间清醒动脉血气（ABG）变化的评估，并对所有患者进行肺功能评估、拟人测量和睡眠前后多导睡眠图和ABG测量。在睡眠中测量经皮二氧化碳分压（Pt，CO2），同时使用动脉二氧化碳分压（Pa，CO2）进行体内校准并校正传感器的漂移。在43%的患者中，Pt，CO2 > 1.33 kPa（10 mmHg）高于清醒基线的睡眠时间大于或等于20%。SH的严重程度最好通过结合基线Pa、CO2、体重指数和快速眼动（REM）睡眠百分比来预测。REM相关的肺通气不足与REM中吸气流量限制的严重程度以及呼吸暂停/呼吸不足指数显著相关。Pa，CO2从夜间到早晨平均增加± SD 0.70 ± 0.65 kPa（5.29 ± 4.92 mmHg），该变化非常显著。Pa、CO的变化与SH的严重程度密切相关。睡眠低通气在高碳酸血症的慢性阻塞性肺疾病中很常见，并且与基线动脉二氧化碳分压、体重指数和上气道阻塞指数有关。睡眠换气不足与夜间到早晨的动脉二氧化碳张力显著增加相关，并可能导致动脉二氧化碳张力长期升高。
Sleep hypoventilation (SH) may be important in the development of hypercapnic respiratory failure in chronic obstructive pulmonary disease (CORD). The prevalence of SH, associated factors, and overnight changes in waking arterial blood gases (ABG), were assessed in 54 stable hypercapnic COPD patients without concomitant sleep apnoea or morbid obesity.Lung function assessment, anthropomorphic measurements, and polysomnography with ABG measurement before and after sleep were conducted in all patients. Transcutaneous carbon dioxide tension (Pt,CO2) was measured in sleep, using simultaneous arterial carbon dioxide tension (Pa,CO2) for in vivo calibration and to correct for drift in the sensor.Of the patients, 43%, spent greater than or equal to 20% of sleep time with Pt,CO2 > 1.33 kPa (10 mmHg) above waking baseline. Severity of SH was best predicted by a combination of baseline Pa,CO2, body mass index and per cent rapid-eye movement (REM) sleep. REM-related hypoventilation correlated significantly with severity of inspiratory flow limitation in REM, and with apnoea/hypopnoea index. Pa,CO2 increased mean +/- SD 0.70 +/- 0.65 kPa (5.29 +/- 4.92 mmHg) from night to morning, and this change was highly significant. The change in Pa,CO, was strongly correlated with severity of SH.Sleep hypoventilation is common in hypercapnic chronic obstructive pulmonary disease, and related to baseline arterial carbon dioxide tension, body mass index and indices of upper airway obstruction. Sleep hypoventilation is associated with significant increases in arterial carbon dioxide tension night-to-morning, and may contribute to long-term elevations in arterial carbon dioxide tension.