切换至 "中华医学电子期刊资源库"
高级检索
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
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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]. 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]. 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
1
Antoniou KM, Margaritopoulos GA, Tomassetti S, et al. Interstitial lung disease[J]. Eur Respir Rev, 2014, 23(131): 40-54.
2
Kim JS, Podolanczuk AJ, Boker P, et al. Obstructive sleep apnea and subclinical interstitial lung disease in the multi-ethnic study of atherosclerosis(MESA)[J]. Ann Am Thorac Soc, 2017, 14(12): 1786-1795.
3
Mavroudi M, Papakosta D, Kontakiotis T, et al. Sleep disorders and health-related quality of life in patients with interstitial lung disease[J]. Sleep Breath, 2018, 22(2): 393-400.
4
Pihtili A, Bingol Z, Kiyan E, et al. Obstructive sleep apnea is common in patients with interstitial lung disease[J]. Sleep Breath, 2013, 17(4): 1281-1288.
5
Lancaster LH, Mason WR, Parnell J, et al. Obstructive sleep apnea is common in idiopathic pulmonary fibrosis[J]. Chest, 2009, 136(3): 772-778.
6
Bosi M, Milioli G, Fanfulla F, et al. OSA and prolonged oxygen desaturation during sleep are strong predictors of poor outcome in IPF[J]. Lung, 2017, 195(5): 643-651.
7
American Thoracic Society, European Respiratory Society. American thoracic society/european respiratory society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001[J]. Am J Respir Critl Care Med, 2002, 165(2): 277-304.
8
葛均波，徐永健，王　辰，主编. 内科学[M]. 北京：人民卫生出版社，2018: 87-97.
9
Berry RB, Brooks R, Gamaldo C, et al. AASM scoring manual updates for 2017 (Version 2.4)[J]. J Clin Sleep Med, 2017, 13(5): 665-666.
10
Warrick JH, Bhalla M, Schabel SI, et al. High resolution computed tomography in early scleroderma lung disease[J]. J Rheumatol, 1991, 18(10): 1520-1528.
11
Diot E, Boissinot E, Asquier E, et al. Relationship between abnormalities on high-resolution CT and pulmonary function in systemic sclerosis[J]. Chest, 1998, 114(6): 1623-1629.
12
Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALATstatement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management[J]. Am J Respir Crit Care Med, 2011, 183(6): 788-824.
13
Mermigkis C, Bouloukaki I, Antoniou K, et al. Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis[J]. Sleep Breath, 2015, 19(1): 385-391.
14
Wang Y, Chen S, Lin JQ, et al. Lung ultrasound B-lines and serum KL-6 correlate with the severity of idiopathic inflammatory myositis-associated interstitial lung disease[J]. Rheumatology(Oxford), 2020, 59(8): 2024-2029.
15
Lee JS, Lee EY, Ha YJ, et al. Serum KL-6 levels reflect the severity of interstitial lung disease associated with connective tissue disease[J]. Arthritis Res Ther, 2019, 21(1): 58.
16
Cofta S, Winiarska HM, Póciniczak A, et al. Oxidative stress markers and severity of obstructive sleep apnea[J]. Adv Exp Med Biol, 2019, 222: 27-35.
17
Wong HS, Williams AJ, Mok YJ. The relationship between pulmonary hypertension and obstructive sleep apnea[J]. Curr Opin Pulm Med, 2017, 23(6): 517-521.
18
Almendros I, Wang Y, Gozal D. The polymorphic and contradictory aspects of intermittent hypoxia[J]. Am J Physiol Lung Cell Mol Physiol, 2014, 307(2): L129-140.
19
Troy LK, Young IH, Lau EMT, et al. Nocturnal hypoxaemia is associated with adverse outcomes in interstitial lung disease[J]. Respirology, 2019, 24(10): 996-1004.
20
Koo P, Gartman EJ, Sethi JM, et al. Change in end-expiratory lung volume during sleep in patients at risk for obstructive sleep apnea[J]. J Clin Sleep Med, 2017, 13(8): 941-947.
21
Krachman SL, Tiwari R, Vega ME, et al. Effect of emphysema severity on the apnea-hypopnea index in smokers with obstructive sleep apnea[J]. Ann Am Thorac Soc, 2016, 13(7): 1129-1135.
22
Mermigkis C, Stagaki E, Trayfon S, et al. How common is sleep-disordered breathing in patients with idiopathic pulmonary fibrosis？[J]. Sleep Breath, 2010, 14(4): 387-390.
23
Romem A, Iacono A, McIlmoyle E, et al. Obstructive sleep apnea in patients with end-stage lung disease[J]. J Clin Sleep Med, 2013, 9(7): 687-693.
24
Sarac S, Kavas M, Sahin M, et al. Relation of Warrick score and polysomnographic parameters in patients with interstitial lung disease[J]. Med Sci Monit, 2019, 25: 2087-2095.
25
Zhang XL, Dai HP, Zhang H, et al. Obstructive sleep apnea in patients with fibrotic interstitial lung disease and COPD[J]. J Clin Sleep Med, 2019, 15(12): 1807-1815.
26
Gille T, Didier M, Rotenberg C, et al. Intermittent hypoxia increases the severity of bleomycin-induced lung injury in mice[J]. Oxid Med Cell Longev, 2018, 2018: 1240192.
27
Pereira N, Cardoso AV, Mota PC, et al. Predictive factors of obstructive sleep apnea in patients with fibrotic lung diseases[J]. Sleep Med, 2019, 56: 123-127.
28
中华医学会，中华医学会杂志社，中华医学会全科医学分会，等. 成人阻塞性睡眠呼吸暂停基层诊疗指南(实践版·2018)[J]. 中华全科医师杂志，2019, 18(1): 30-35.
29
Veasey SC, Rosen IM. Obstructive sleep apnea in adults[J]. N Engl J Med, 2019, 380(15): 1442-1449.
[1] 金姗, 丁雪晏, 蔡绮哲, 李一丹, 赵智玲, 郭兮恒, 吕秀章. 左心室压力-应变环对阻塞型睡眠呼吸暂停综合征患者心肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 575-580.
[2] 陈腊青, 林佳佳, 毛洪刚, 童冠海, 汪梦娜, 夏红波, 刘卓, 徐海霞, 赵玉华, 张传领. 血清细胞因子及呼出气一氧化氮在哮喘-慢性阻塞性肺疾病重叠综合征中的临床意义[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 316-320.
[3] 周杉京, 诸葛金科, 王芳芳. 补肺活血胶囊对COPD患者cCor、ALD、Ang-Ⅱ的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 517-519.
[4] 吴庆华, 冒勇, 闫效坤. AECOPD并发AKI的危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 529-531.
[5] 芦丹, 杨硕, 刘旭. VEGF、HMGB1、hs-CRP/Alb在AECOPD伴呼吸衰竭中的变化及预后分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 532-534.
[6] 熊锋, 娄建丽. 慢性阻塞性肺疾病急性加重期预后的临床分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 550-553.
[7] 王庆, 张红联, 吴志勇. COPD合并多重耐药菌肺部感染预后危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 557-559.
[8] 林静, 陈芳, 刘小霞. COPD患者认知功能障碍影响因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 569-571.
[9] 张七妹, 麦宜准, 蒋浩波. 喘可治对慢性阻塞性肺疾病缓解期的临床分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 578-580.
[10] 张林, 刘芳, 赵静, 刘勇, 周青. 远程康复在慢性阻塞性肺疾病患者肺康复中的研究进展[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 601-604.
[11] 唐英俊, 李华娟, 王赛妮, 徐旺, 刘峰, 李羲, 郝新宝, 黄华萍. 人脐带间充质干细胞治疗COPD小鼠及机制分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 476-480.
[12] 徐丽玲, 卢玉宝, 赵彦, 任利, 李姝艺, 符娟, 康玲, 汪青松, 尤再春. COPD管理云平台的构建及临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 481-484.
[13] 李海明, 刘鸿飞, 李俊. 血清脂蛋白酶水平与COPD患者骨骼肌质量减少的关系[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 500-503.
[14] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
[15] 孙培培, 张二明, 时延伟, 赵春燕, 宋萍萍, 张硕, 张克, 周玉娇, 赵璨, 闫维, 吴蓉菊, 宋丽萍, 郭伟安, 马石头, 安欣华, 包曹歆, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病患病情况及相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 711-719.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号