Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia
Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia
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DOI：
10.1371/journal.pone.0152749
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发表时间：
2016-04-06
期刊：
影响因子：
3.7
通讯作者：
Barbe, Ferran
中科院分区：
文献类型：
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作者：
Chiner, Eusebi;Llombart, Monica;Barbe, Ferran
背景我们假设阻塞性睡眠呼吸暂停(OSA)易导致下呼吸道感染和上呼吸道微吸入性肺炎(CAP)。本研究评估了OSA与CAP的关系。方法我们进行了一项病例对照研究，包括82例CAP患者和41例其他感染患者(对照组)。对照组根据年龄、性别和体重指数(BMI)进行匹配。两组患者入院时均行呼吸测谎仪(RP)检查。根据肺炎严重程度指数(PSI)评估肺炎严重程度。采用Logistic回归模型分析CAP与Epworth嗜睡量表(ESS)、阻塞性睡眠呼吸暂停综合征(OSA)、阻塞性睡眠呼吸暂停综合征严重程度等睡眠相关变量的关系。用线性回归模型和非参数检验分析OSA、OSA严重程度与CAP严重程度的关系。结果CAP患者的人体测量学变量、中毒习惯和CAP危险因素与对照组无显著差异。睡眠呼吸暂停低通气指数(AHI)和呼吸暂停低通气指数(GT；)=10的OSA患者发生CAP的风险增加(OR=2.86，95%可信区间1.29-6.44，P=0.01)。重度阻塞性睡眠呼吸暂停患者发生慢性阻塞性肺疾病的风险也较高(OR=3.18，95%CI1.11~11.56，p=0.047)。此外，根据呼吸紊乱指数四分位数定义的阻塞性睡眠呼吸暂停严重程度也与慢性阻塞性肺疾病显著相关(p=0.007)。此外，阻塞性睡眠呼吸暂停与慢性阻塞性肺疾病严重程度显著相关(p=0.0002)，阻塞性睡眠呼吸暂停严重程度也与慢性阻塞性肺疾病严重程度相关(p=0.0006)。此外，OSA和OSA严重程度与CAP严重程度相关。这些结果支持OSA在CAP发病机制中的潜在作用，并可能具有临床意义。应探讨OSA和感染风险之间的联系，以研究胃食道反流、静默误吸、喉感觉障碍和CAP之间的关系。
BackgroundWe hypothesized that obstructive sleep apnea (OSA) can predispose individuals to lower airway infections and community-acquired pneumonia (CAP) due to upper airway microaspiration. This study evaluated the association between OSA and CAP.MethodsWe performed a case-control study that included 82 patients with CAP and 41 patients with other infections (control group). The controls were matched according to age, sex and body mass index (BMI). A respiratory polygraph (RP) was performed upon admission for patients in both groups. The severity of pneumonia was assessed according to the Pneumonia Severity Index (PSI). The associations between CAP and the Epworth Sleepiness Scale (ESS), OSA, OSA severity and other sleep-related variables were evaluated using logistic regression models. The associations between OSA, OSA severity with CAP severity were evaluated with linear regression models and non-parametric tests.FindingsNo significant differences were found between CAP and control patients regarding anthropometric variables, toxic habits and risk factors for CAP. Patients with OSA, defined as individuals with an Apnea-Hypopnea Index (AHI) >= 10, showed an increased risk of CAP (OR = 2.86, 95% CI 1.29-6.44, p = 0.01). Patients with severe OSA (AHI >= 30) also had a higher risk of CAP (OR = 3.18, 95% CI 1.11-11.56, p = 0.047). In addition, OSA severity, defined according to the AHI quartile, was also significantly associated with CAP (p = 0.007). Furthermore, OSA was significantly associated with CAP severity (p = 0.0002), and OSA severity was also associated with CAP severity (p = 0.0006).ConclusionsOSA and OSA severity are associated with CAP when compared to patients admitted to the hospital for non-respiratory infections. In addition, OSA and OSA severity are associated with CAP severity. These results support the potential role of OSA in the pathogenesis of CAP and could have clinical implications. This link between OSA and infection risk should be explored to investigate the relationships among gastroesophageal reflux, silent aspiration, laryngeal sensory dysfunction and CAP.