Polysomnographic features of low arousal threshold in overlap syndrome involving obstructive sleep apnea and chronic obstructive pulmonary disease
Polysomnographic features of low arousal threshold in overlap syndrome involving obstructive sleep apnea and chronic obstructive pulmonary disease
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阻塞性睡眠呼吸暂停和慢性阻塞性肺疾病重叠综合征低觉醒阈值的多导睡眠图特征
DOI：
10.1007/s11325-019-01786-7
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Fukuchi Y
中科院分区：
文献类型：
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作者：
Yamaguchi Y;Shiota S;Kusunoki Y;Hamaya H;Ishii M;Kodama Y;Akishita M;Kida K;Takahashi K;Nagase T;Fukuchi Y
目的在重叠综合征 (OVS) 患者中，阻塞性睡眠呼吸暂停 (OSA) 和慢性阻塞性肺病的病理生理学可以相互作用。作者着眼于低唤醒阈值，评估了 OVS 患者的多导睡眠图特征。方法这项回顾性、多中心研究在日本三家医院进行。对年龄≥60岁且接受多导睡眠图和肺功能测试的患者进行了回顾。气流受限（AFL）的严重程度根据慢性阻塞性肺病全球倡议标准进行分类。低唤醒阈值是根据以下多导睡眠图特征预测的：较低的呼吸暂停低通气指数（AHI）；更高的最低氧饱和度，以及总呼吸事件中更大的呼吸不足比例。在仅患有 OSA (n= 126)、OVS 患有轻度 AFL (n= 16) 和 OVS 患有中度/重度 AFL (n= 22) 的患者中对这些特征进行了比较。 结果 患有中度/重度 AFL 的 OVS 患者比仅患有 OSA (p= 0.016) 和 OVS 患有轻度 AFL 的患者更频繁地表现出低唤醒阈值（p= 0.026）。随着 OVS 患者 1 秒用力呼气量/用力肺活量 (FEV1/FVC) 的减少，呼吸暂停的平均长度减少 (r= 0.388，p= 0.016)，呼吸不足分数增加 (r= − 0.337，p= 0.039)，AHI 下降（r= 0.424，p= 0.008）。 FEV1/FVC 导致低觉醒阈值，与所有受试者（OR 0.946 [95% CI 0.909–0.984]）和 OVS 患者（OR 0.799 [95% CI 0.679–0.940]）的年龄、性别、吸烟史、医院或体重指数无关。结论本研究首先描述了患有中度/重度 AFL 的 OVS 患者的特殊多导睡眠图特征，表明低唤醒阈值的患病率很高。
PurposeIn patients with overlap syndrome (OVS), the pathophysiologies of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease can interact with one another. Focusing on low arousal threshold, the authors evaluated polysomnographic features of OVS patients.MethodsThis retrospective, multicenter study was conducted at three hospitals in Japan. Patients aged ≥ 60 years who underwent polysomnography and pulmonary function testing were reviewed. Severity of airflow limitation (AFL) was classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria. Low arousal threshold was predicted based on the following polysomnography features: lower apnea-hypopnea index (AHI); higher nadir oxygen saturation, and larger hypopnea fraction of total respiratory events. These features were compared among patients with only OSA (n= 126), OVS with mild AFL (n= 16), and OVS with moderate/severe AFL (n= 22).ResultsA low arousal threshold was more frequently exhibited by OVS patients with moderate/severe AFL than by those with OSA only (p= 0.016) and OVS with mild AFL (p= 0.026). As forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) decreased in OVS patients, the mean length of apnea decreased (r= 0.388,p= 0.016), hypopnea fractions increased (r= − 0.337,p= 0.039), and AHI decreased (r= 0.424,p= 0.008). FEV1/FVC contributed to low arousal threshold independent of age, sex, smoking history, hospital, or body mass index in all subjects (OR 0.946 [95% CI 0.909–0.984]) and in OVS patients (OR 0.799 [95% CI 0.679–0.940]).ConclusionsThis study first described peculiar polysomnographic features in OVS patients with moderate/severe AFL, suggesting a high prevalence of low arousal threshold.