慢性阻塞性肺疾病患者睡眠呼吸紊乱类型及其与呼吸中枢反应性的关系  

Respiration control dysfunction and the relationship to sleep-disordered breathing in patients with chronic obstructive pulmonary disease

作　　者：何忠明[1] 崔小川[2] 李静[1] 董霄松[1] 吕云辉[1] 周敏[2] 韩旭[1] 安培[1] 王丽[1] 张荣葆[1] 何权瀛[1] 韩芳[1] 

机构地区：[1]北京大学人民医院呼吸科 [2]无锡市第五人民医院呼吸科

出　　处：《中华结核和呼吸杂志》2007年第9期673-676,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金(30300120);克拉玛依市科技计划项目资助项目(SK2007-21)

摘　　要：目的分析重叠综合征[慢性阻塞性肺疾病(COPD)合并睡眠呼吸暂停低通气综合征(SAHS)]患者睡眠呼吸紊乱的特点,并探讨其与呼吸中枢反应性的关系。方法对300例稳定期COPD 患者经问卷、Epworth 嗜睡量表及家庭血氧饱和度监测,对氧减饱和指数>5次/h 或嗜睡评分≥10分的患者进行多导生理记录仪睡眠呼吸监测,其中呼吸暂停低通气指数(AHI)≥10次/h 的患者有79例(重叠综合征组)。选择年龄、性别及体重指数与其相匹配的118例单纯 SAHS 患者(SAHS组),对比分析其睡眠呼吸紊乱的特点。另外测定重叠综合征组22例患者的呼吸中枢高 CO_2反应性和低氧反应性,并与300例 COPD 患者中17例和 SAHS 组中17例的相应检测结果进行比较。结果40%(32/79)的重叠综合征患者在睡眠过程中出现延续时间>1 min 的持续肺泡通气不足,但单纯SAHS 患者此种现象很少见。重叠综合征组的低通气指数占 AHI 百分比[(69±30)%]、总低通气时间占总睡眠时间百分比[(15±12)%]均较单纯 SAHS 组[(52±31)%、(12±10)%]明显增高。重叠综合征患者在清醒状态下的Δ呼气流量/Δ动脉血氧饱和度[(-0.11±0.05)L·min^(-1)·%^(-1)]和Δ呼气流量/Δ动脉血二氧化碳分压[(1.1±0.8)L·min^(-1)·mm Hg^(-1)(1 mm Hg=0.133 kPa)]均明显低于单纯 SAHS 患者[(-0.35±0.24)L·min^(-1)·%^(-1)和(1.6±0.8)L·min^(-1)·mm Hg^(-1)]。结论重叠综合征患者的睡眠呼吸紊乱模式以低通气为主,其清醒时呼吸中枢的低氧反应性降低。Objective To analyze the polysomnographic （PSG） features of sleep apnea hypopnea syndrome （SAHS） in patients with chronic obstructive pulmonary disease （COPD）, and to define the association between SAHS and respiratory control disorder. Methods Three hundred patients with stable COPD were screened for SAHS using questionnaire, Epworth sleep scale （ESS） and home pulse oximeter testing. Those with ESS≥10 or oxygen desaturation over 3% more than 5 times per hour sleep were under further PSG testing. The PSG features were compared between COPD patients with apnea hypopnea index （AHI） 〉 10 and 118 SAHS patients with normal lung function. The two groups were matched for age, body mass index （BMI） and AHI. Among them 22 with COPD and AHI ≥ 10 were tested for the chemoresponsiveness to isocapnic hypoxia and hypercapnia. Results Among the 300 patients with stable COPD, 79 had AHI over 10, meeting the diagnostic criteria of overlap syndrome （OS）. Analysis of the polysomnography found that 32 cases （40%） with OS had more hypoventilation lasting over 1 min during sleep. Compared to patients with SAHS only, OS patients had higher percentage of hypopnea index over AHI [ （69 ± 30）% vs （52 ± 31 ）% ] and a higher percentage of total hypopnea time over total time of sleep apnea and hypopnea [ （ 15 ± 12）% vs （ 12 ± 10）% ]. OS patients also had lower hypoxic [ （ -0. 11 ± 0. 05） vs （ - 0. 35 ± 0. 24） L · min^-1· %^-1 ] and hypercapnic responses [ （ 1.1 ± 0. 8 ） vs （ 1.6 ± 0. 8 ）L · min^-1 ·mm Hg^-1 （ 1 mm Hg = 0. 133 kPa） ]. Conclusion Patients with both COPD and SAHS had more episodes of hyponea and hypoventilation during sleep, and had depressed chemo-responsiveness to hypoxia during wakefulness.

关 键 词：肺疾病 阻塞性 睡眠呼吸暂停 阻塞性 重叠综合征 

分 类 号：R563.9[医药卫生—呼吸系统]