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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2021, Vol. 14 ›› Issue (02) : 146 -151. doi: 10.3877/cma.j.issn.1674-6902.2021.02.003

论著

阻塞性睡眠呼吸暂停与间质性肺疾病严重程度的临床分析
李菲1, 张臣2, 窦瑞雨2, 谢江1,†()   
  1. 1. 100029　北京，首都医科大学附属北京安贞医院呼吸与危重症医学科
    2. 100029　北京，首都医科大学附属北京安贞医院影像科
  • 收稿日期:2020-10-15 出版日期:2021-04-25
  • 通信作者: 谢江
  • 基金资助:
    国家自然科学基金面上项目(81970079)

Association of obstructive sleep apnea with the severity of cardiopulmonary impairment in patients with interstitial lung disease

Fei Li1, Chen Zhang2, Ruiyu Dou2, Jiang Xie1,†()   

  1. 1. Department of Pulmonary and Critical Care Medicine, Beijing An-Zhen Hospital, Capital Medical University, Beijing 100029, China
    2. Department of Radiology and Imaging, Beijing An-Zhen Hospital, Capital Medical University, Beijing 100029, China
  • Received:2020-10-15 Published:2021-04-25
  • Corresponding author: Jiang Xie
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李菲, 张臣, 窦瑞雨, 谢江. 阻塞性睡眠呼吸暂停与间质性肺疾病严重程度的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2021, 14(02): 146-151.

Fei Li, Chen Zhang, Ruiyu Dou, Jiang Xie. Association of obstructive sleep apnea with the severity of cardiopulmonary impairment in patients with interstitial lung disease[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(02): 146-151.

目的

分析阻塞性睡眠呼吸暂停(OSA)合并间质性肺疾病(ILD)患者的临床资料，探讨OSA与ILD患者疾病严重程度的关系。

方法

回顾性分析2010年2月至2019年12月于我院诊治的51例ILD合并OSA患者的临床资料，包括动脉血气分析、B型脑钠肽，以及睡眠呼吸监测、肺功能检查、心脏彩色多普勒超声检查等数据，采用Warrick评分方法评估ILD病变严重程度和范围。分析睡眠参数与ILD患者心肺功能、肺间质病变严重程度的关系，探索预测重度肺间质病变的相关指标。

结果

ILD-OSA患者睡眠最低血氧饱和度与三尖瓣返流速率(TRV)负相关(r＝-0.415，P＝0.028)，氧减指数与BNP正相关(rs＝0.409，P＝0.031)，血氧饱和度低于90%的时间占总睡眠时间的比例(TST90)与肺动脉收缩压、TRV、BNP均呈正相关(rs＝0.505、0.584、0.455，P＝0.006、0.001、0.015)，TST90与肺一氧化碳弥散量负相关(rs＝-0.458，P＝0.028)。二元Logistic回归分析显示，TST90与ILD重度肺间质病变有显著相关性(P＝0.036，OR＝1.025，95%CI＝1.002～1.049)，TST90 1.8%为预测重度肺间质病变的最佳截断值，ROC分析曲线下面积为0.719(P＝0.013，95%CI＝0.564～0.875)，敏感性为89.9%，特异性为53.6%。

结论

睡眠间歇性低氧与ILD患者心肺功能、肺间质病变严重程度有一定相关性，TST90是ILD患者心肺功能差、肺间质病变程度重的独立相关性因素。

关键词: 低通气综合征, 睡眠呼吸暂停, 阻塞性, 间歇性低氧, 间质性肺疾病
Objective

To explore the relationship of obstructive sleep apnea(OSA)with the severity of cardiopulmonary involvement in patients with interstitial lung disease(ILD).

Methods

A total of 51 patients with concomitant ILD and OSA treated from February 2010 to December 2019 in Beijing Anzhen Hospital were analyzed of arterial blood gas analysis, BNP, sleeping test, spirometry, echocardiography, etc. The severity and extent of ILD lesions were determined by Warrick scoring algorithm.

Results

In patients with ILD-OSA, the lowest oxygen saturation (LSpO2) was negatively correlated with tricuspid regurgitation velocity (TRV) (r=-0.415, P=0.028). Oxygen depletion index (ODI) was positively correlated with BNP (rs=0.409, P=0.031). The percentage total sleep time with SpO2<90% (TST90) was positively correlated with systolic pulmonary artery pressure, TRV and BNP (rs=0.505, P=0.006, rs=0.584, P=0.001, and rs=0.455, P=0.015), and was negatively correlated with lung carbon monoxide diffusion capacity (DLCO) (rs=-0.458, P=0.028). Logistic regression revealed that TST90 was significantly associated with severe ILD defined by fibrostic Warrick degrees (P=0.036, OR=1.025, 95%CI=1.002-1.049). TST90 1.8% was the best cut-off values for discrimination of severe pulmonary fibrosis, and the area under the curve was 0.719, which resulted in a sensitivity of 89.9% and a specificity of 53.6%.

Conclusion

OSA related intermittent nocturnal hypoxemia was associated with the severity of cardiopulmonary involvement in patients with ILD, and subjects with long desaturation defined by TST90 demonstrated high odds of having severe fibrotic stratification.

Key words: Obstructive sleep apnea hypopnea syndrome, Intermittent hypoxia, Interstitial lung disease
图1 患者HRCT表现；注：A：箭头所指可见双肺上叶小叶间隔增厚；B：箭头所指可见双肺下叶蜂窝影及不规则胸膜边缘；C：箭头所指可见双肺下叶磨玻璃影及小叶间隔增厚
表1 患者临床特征[n(%)]
临床资料 统计量
吸烟史  
  无 19(37.3)
  既往吸烟 21(41.2)
  现吸烟 11(21.6)
BMI(kg/m2) 26.79±2.90
BNP(pg/ml) 90.50(32.75，273.50)
PaO2(mmHg) 69.35±12.44
右心功能  
  TRV(m/s) 302.10±94.12
  SPAP(mmHg) 50.31±27.30
肺功能  
FEV1%预计值 80.51±19.92
FVC%预计值 70.84±11.71
TLC%预计值 70.81±6.69
DLCO%预计值 51.15±19.28
Warrick评分 10.51±5.19
睡眠监测指标  
  AHI(次/h) 21.79±16.95
  LSpO2(%) 80.75±6.60
  ODI(次/h) 21.19±14.11
  TST90(%) 6.60(0.83，32.83)
图2 睡眠参数与ILD患者心肺功能指标的相关性；注：A：BNP与TST90的相关关系；B：SPAP与TST90的相关关系；C：TRV与TST90的相关关系；D：DLCO与TST90的相关关系；E：TRV与LSpO2的相关关系；F：BNP与ODI的相关关系
表2 睡眠参数与ILD肺间质病变程度的Logistic分析结果
项　目 未校正 校正a
P值 OR值 95%CI P值 OR值 95%CI
AHI 0.523 1.011 0.978～1.045 0.916 0.998 0.963～1.035
TST90 0.036 1.025 1.002～1.049 0.045 1.029 1.000～1.059
ODI 0.070 1.043 0.996～1.092 0.179 1.038 0.983～1.096
LSpO2 0.218 0.945 0.863～1.034 0.164 0.931 0.843～1.029
图3 TST90预测重度肺间质病变的ROC曲线
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