阻塞性睡眠呼吸暂停对间质性肺疾病患者的预后分析  

Retrospective investigation of the prognostic impact of obstructive sleep apnea upon patients with interstitial lung diseases

作　　者：李菲[1] 谢江[1] LI Fei;XIE Jiang(Department of Pulmonary and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所呼吸与危重症医学科,100029

出　　处：《心肺血管病杂志》2024年第3期267-273,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金面上项目(81970079)。

摘　　要：目的:通过分析阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)合并间质性肺疾病(interstitial lung diseases,ILD)患者的临床资料,揭示OSA与ILD患者病情严重程度的关联,评估睡眠参数对ILD患者预后的影响。方法:回顾性收集2011年2月至2021年2月,于北京安贞医院呼吸与危重症医学科完成睡眠监测的ILD患者,定义呼吸暂停低通气指数≥15次/h为OSA。所有患者均完成超声心动图,以三尖瓣反流峰值流速>3.4m/s或2.9~3.4m/s伴右心室增大伴室壁增厚,且主肺动脉直径>25mm、右心室/左心室横径>1作为判断肺动脉高压(hypertension,PH)的标准。通过阅读病历和电话回访的方式确定患者预后状况。结果:全部61例ILD患者,30例合并OSA,OSA组患者BMI高于非OSA组患者[(28.1±2.5)vs.(26.1±3.0)kg/m2,P=0.008],最低血氧饱和度(lowest blood oxygen saturation,LSpO2)显著低于非OSA患者[(79.2±7.5)%vs.(83.6±3.9)%,P=0.008],但睡眠血氧饱和度低于90%的时间占总睡眠时间的比例(90%in the total sleep time,TST90)两组间差异无统计学意义。二元Logistic回归单因素分析结果显示,清醒状态PaO2、肺间质病变程度、TST90、LSpO2与ILD患者发生PH相关。多因素分析后,TST90≥20%仍是ILD患者合并PH的独立相关因素(OR=9.460,95%CI:2.093~42.749,P=0.004)。Kaplan-Meier生存分析显示,未合并PH的ILD患者总体生存状况显著优于合并PH的ILD患者(χ^(2)=5.150,P=0.023),TST90<20%的患者总体生存状况显著优于TST90≥20%的患者(χ^(2)=5.728,P=0.017)。Cox回归模型显示TST90≥20%的ILD患者死亡风险高于TST90<20%者(HR=3.263,95%CI:1.171~9.093,P=0.024),在矫正年龄、性别等混杂因素后仍显著(HR=3.862,95%CI:1.075~13.873,P=0.038)。结论:睡眠呼吸暂停所致的夜间低氧与ILD患者PH的发生独立相关,并显著增加ILD患者的死亡风险,易于监测的夜间间歇低氧可能是评估ILD患者病情和判断预后的有效指标。Objective:To investigate the prognostic impact of obstructive sleep apnea(OSA)upon patients with interstitial lung diseases(ILD),and toevaluate the effect of sleep parameters on the prognosis of ILD patients.Methods:ILD patients who completed sleep monitoring in Beijing Anzhen Hospital from February 2011 to February 2021 were retrospectively collected,and OSA was defined as apnea-hypopnea index≥15 times/hour.Echocardiography was completed in all patients,with peak tricuspid regurgitation velocity(TRV)>3.4m/s or TRV 2.9-3.4m/s complicated with right ventricular enlargement and wall thickening,and main pulmonary artery diameter>25mm,ratio of right ventricle and left ventricular transverse diameter>1 as the criterion for pulmonary hypertension(PH).The patients'prognosis was determined via case readings and telephone interviews.Results:Among all 61 ILD patients included,30 were overlapped with OSA.The BMI of the OSA group was higher than that of the non-OSA group[(28.1±2.5)vs.(26.1±3.0)kg/m2,P=0.008],and the lowest blood oxygen saturation(LSpO2)was significantly lower than that of non-OSA group[(79.2±7.5)%vs.(83.6±3.9)%,P=0.008].Univariate analysis showed that PaO2,the severity of interstitial lung disease,the proportion of the time when the sleep oxygen saturation was lower than 90%in the total sleep time(TST90),and LSpO2 were related to the occurrence of PH in patients with ILD.Multivariate analysis showed that TST90≥20%retained to be an independent correlative factor for occurrence of PH(OR=9.460,95%CI:2.093-42.749,P=0.004).Kaplan-Meier survival analysis showed that the overall survival of ILD patients without PH was significantly better than that of ILD patients with PH(χ^(2)=5.150,P=0.023),and the overall survival of patients with TST90<20%was superior to that of patients with TST90≥20%patients(χ^(2)=728,P=0.017).Cox regression model showed that ILD patients with TST90≥20%had a higher mortality risk than those with TST90<20%(HR=3.263,95%CI:1.171-9.093,P=0.024)with significance persisting after conf

关 键 词：阻塞性睡眠呼吸暂停 间质性肺疾病 夜间低氧 

分 类 号：R54[医药卫生—心血管疾病]