Clinical efficacy analysis of noninvasive positive pressure ventilation in the treatment of acute exacerbation of 138 patients of chronic obstructive pulmonary disease combined with obstructive sleep apnea

doi:10.3877/cma.j.issn.1674-6902.2026.02.008

Abstract

Abstract:

Objective

To investigate the factors influencing the efficacy of non-invasive positive pressure ventilation (NIPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with obstructive sleep apnea (OSA), and to evaluate the clinical value of different nocturnal ventilation strategies.

Methods

A retrospective analysis was conducted on 138 patients with AECOPD complicated by OSA admitted to our hospital from April 2022 to December 2025. Based on the therapeutic effect of NIPPV during hospitalization, patients were divided into two groups: 93 cases in the observation group (effective treatment) and 45 cases in the control group (ineffective treatment). General data, arterial blood gas parameters, sleep monitoring data, and ventilation parameters were collected from both groups. Univariate and multivariate logistic regression analyses were used to identify factors influencing the therapeutic effect.

Results

Univariate analysis showed that body mass index (BMI), arterial partial pressure of carbon dioxide (PaCO₂), positive end-expiratory pressure (PEEP), NIPPV initiation delay time, nocturnal ventilation strategy, apnea-hypopnea index (AHI), and minimum pulse oxygen saturation (miniSpO₂) were associated with the efficacy of NIPPV (P<0.05). Multivariate logistic regression analysis revealed that BMI (OR=0.87, P=0.024), PaCO₂ (OR=0.94, P=0.006), and AHI (OR=0.91, P=0.005) were negative predictors; whereas ΔPEEP increment (OR=1.88, P=0.004), shorter NIPPV delay time (OR=0.78, P=0.019), active nocturnal PEEP up-titration (OR=4.26, P=0.002), and higher miniSpO₂ (OR=1.12, P=0.009) were protective factors. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.839.

Conclusion

High BMI, PaCO₂, and AHI, moderate nocturnal increase in PEEP, early initiation of NIPPV, and high oxygen saturation can improve the therapeutic effect of NIPPV in patients with AECOPD combined with OSA. Optimizing ventilation parameters and intervention timing has clinical significance for enhancing ventilation efficiency and sleep quality in these patients.

Key words: Chronic obstructive pulmonary disease, Obstructive sleep apnea, Non-invasive ventilation, Hypercapnic respiratory failure, Positive end-expiratory pressure

Caicai Wang, Lijing Cui, Yuan Wang, Yuehuan Sun, Shaoqing Xu, Liang Wang. Clinical efficacy analysis of noninvasive positive pressure ventilation in the treatment of acute exacerbation of 138 patients of chronic obstructive pulmonary disease combined with obstructive sleep apnea[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(02): 234-239.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2026.02.008

https://zhfbjbzz.cma-cmc.com.cn/EN/Y2026/V19/I02/234

Figures/Tables 4

References 30

1	Boers E, Barrett M, Su JG, et al. Global burden of chronic obstructive pulmonary disease through 2050[J]. JAMA Netw Open, 2023, 6(12): e2346598- e2346598.
2	Ferrera MC, Labaki WW, Han MK. Advances in chronic obstructive pulmonary disease[J]. Annu Rev Med, 2021, 72: 119-134.
3	Wang Z, Locantore N, Haldar K, et al. Inflammatory endotype-associated airway microbiome in chronic obstructive pulmonary disease clinical stability and exacerbations: A multicohort longitudinal analysis[J]. Am J Respir Crit Care Med, 2021, 203(12): 1488-1502.
4	Qian Y, Cai C, Sun M, et al. Analyses of factors associated with acute exacerbations of chronic obstructive pulmonary disease: A review[J]. Int J Chron Obstruct Pulmon Dis, 2023, 18: 2707-2723.
5	陈艳，李晓梅. 老年COPD患者急性加重期并发呼吸衰竭危险因素及风险模型构建[J]. 中国老年学杂志，2022, 42(22): 5478-5480.
6	Machado A, Barusso M, De Brandt J, et al. Impact of acute exacerbations of COPD on patients′ health status beyond pulmonary function: A scoping review[J]. Pulmonology, 2023, 29(6): 518-534.
7	Carron M, Freo U, Bahammam AS, et al. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials[J]. Brit J Anaesthes, 2013, 110(6): 896-914.
8	Coleman JM, Wolfe LF, Kalhan R. Noninvasive ventilation in chronic obstructive pulmonary disease[J]. Ann Am Thorac Soc, 2019, 16(9): 1091-1098.
9	Czerwaty K, Dzaman K, Sobczyk KM, et al. The overlap syndrome of obstructive sleep apnea and chronic obstructive pulmonary disease: A systematic review[J]. Biomedicines, 2022, 11(1): 16-16.
10	Azarbarzin A, Vena D, Esmaeili N, et al. Cardiovascular benefit of continuous positive airway pressure according to high-risk obstructive sleep apnoea: a multi-trial analysis[J]. Eur Heart J, 2025: ehaf447.
11	Solelhac G, Sánchez-de-la-torre M, Blanchard M, et al. Pulse wave amplitude drops index: A biomarker of cardiovascular risk in obstructive sleep apnea[J]. Am J Respir Crit Care Med, 2023, 207(12): 1620-1632.
12	Lin HC, Friedman M. Volumetric tongue reduction for obstructive sleep apnea[J]. Sleep Med Clin, 2019, 14(1): 59-65.
13	Zeineddine S, Rowley JA, Chowdhuri S. Oxygen therapy in sleep-disordered breathing[J]. Chest, 2021, 160(2): 701-717.
14	Banjade P, Kandel K, Itani A, et al. The interplay between obstructive sleep apnea, chronic obstructive pulmonary disease, and congestive heart failure: Time to collectively refer to them as triple overlap syndrome？[J]. Medicina (Kaunas), 2023, 59(8): 1374-1374.
15	Jayadev A, Stone R, Steiner MC, et al. Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits[J]. BMJ Open Respir Res, 2019, 6(1): e000444.
16	Akbaʂ T, Altun G. Treatment of critically ill patients with acute hypercarbic respiratory failure by average volume-assured pressure support mode[J]. Clin Respir J, 2021, 15(9): 973-982.
17	Van DE Perck E, Kazemeini E, Van den Bossche K, et al. The effect of CPAP on the upper airway and ventilatory flow in patients with obstructive sleep apnea[J]. Respir Res, 2023, 24(1): 143-143.
18	Hedsund C, Linde Ankjærgaard K, Peick Sonne T, et al. Long-term non-invasive ventilation for COPD patients following an exacerbation with acute hypercapnic respiratory failure: a randomized controlled trial[J]. Eur Clin Respir J, 2023, 10(1): 2257993-2257993.
19	谭伟，孙龙凤，代冰，等. 慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者使用无创正压通气成功的临床预测因素研究[J]. 中国全科医学，2013, 16(2): 147-150.
20	王丹，王昌锋，王丽，等. 慢性阻塞性肺疾病患者认知功能减退与睡眠呼吸暂停程度临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(3): 390-394.
21	Marin JM, Soriano JB, Marin-oto M, et al. Sleep-disordered breathing in patients with chronic obstructive pulmonary disease: prevalence and outcomes[J]. Ann Am Thorac Soc, 2025, 22(8): 1227-1235.
22	Nguyen BHM, Murphy PB, Yee BJ. Chronic obstructive pulmonary disease and obstructive sleep apnea overlap syndrome: An update on the epidemiology, pathophysiology, and management[J]. Sleep Med Clin, 2024, 19(3): 405-417.
23	Wang N, Qin H, Bao L. The role of the AVAPS ventilation mode combined with TCM monitoring in weaning patients with AECOPD[J]. Sci Rep, 2025, 15(1): 4722-4722.
24	Sleeper G, Rashidi M, Strohl KP, et al. Comparison of expiratory pressures generated by four different EPAP devices in a laboratory bench setting[J]. Sleep Med, 2022, 96: 87-92.
25	王晶，陈曦，孙宁，等. COPD合并阻塞性睡眠呼吸暂停低通气综合征的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2022, 15(6): 819-821.
26	Kuna ST, Reboussin DM, Strotmeyer ES, et al. Effects of weight loss on obstructive sleep apnea severity. Ten-year results of the sleep AHEAD study[J]. Am J Respir Crit Care Med, 2021, 203(2): 221-229.
27	Bjornsdottir E, Keenan BT, Eysteinsdottir B, et al. Quality of life among untreated sleep apnea patients compared with the general population and changes after treatment with positive airway pressure[J]. J Sleep Res, 2015, 24(3): 328-338.
28	Liang YR, Lan CC, Su WL, et al. Factors and outcomes associated with failed noninvasive positive pressure ventilation in patients with acute respiratory failure[J]. Int J Gen Med, 2022, 15: 7189-7199.
29	杨柳，骆小华，王海峰，等. 肥胖型阻塞性睡眠呼吸暂停患者的睡眠监测特点分析[J]. 世界睡眠医学杂志，2025, 12(2): 263-267, 271.
30	Malhotra A, Grunstein RR, Fietze I, et al. Tirzepatide for the treatment of obstructive sleep apnea and obesity[J]. N Engl J Med, 2024, 391(13): 1193-1205.

临床资料	观察组(n＝93)	对照组(n＝45)	t/χ²值	P值
BMI[kg/m²，(±s)]	24.65±2.87	26.21±3.12	－2.825	0.004
COPD病程[年，(±s)]	10.45±4.83	11.13±5.02	－0.755	0.471
吸烟指数[包/年，(±s)]	41.75±15.24	44.23±14.62	－0.921	0.385
pH(±s)	7.31±0.05	7.28±0.06	2.902	0.018
PaO₂[mmHg, (±s)]	58.63±9.41	56.84±8.75	1.099	0.243
PaCO₂[mmHg, (±s)]	58.31±8.13	64.56±9.22	－3.877	0.000
高血压[n(%)]	37 (39.78)	21 (46.67)	0.590	0.457
糖尿病[n(%)]	19 (20.43)	12 (26.67)	0.677	0.425
冠心病[n(%)]	15 (16.13)	9 (20.00)	0.316	0.565
ΔPEEP(cmH₂O)	2.83±0.94	1.97±0.86	5.340	0.003
NIPPV延迟时间(h)	4.21±1.75	6.12±2.35	－4.842	0.002
夜间主动上调PEEP[n(%)]	61 (65.59)	15 (33.33)	12.757	0.000

临床资料	观察组(n＝93)	对照组(n＝45)	t/χ²值	P值
BMI[kg/m²，(±s)]	24.65±2.87	26.21±3.12	－2.825	0.004
COPD病程[年，(±s)]	10.45±4.83	11.13±5.02	－0.755	0.471
吸烟指数[包/年，(±s)]	41.75±15.24	44.23±14.62	－0.921	0.385
pH(±s)	7.31±0.05	7.28±0.06	2.902	0.018
PaO₂[mmHg, (±s)]	58.63±9.41	56.84±8.75	1.099	0.243
PaCO₂[mmHg, (±s)]	58.31±8.13	64.56±9.22	－3.877	0.000
高血压[n(%)]	37 (39.78)	21 (46.67)	0.590	0.457
糖尿病[n(%)]	19 (20.43)	12 (26.67)	0.677	0.425
冠心病[n(%)]	15 (16.13)	9 (20.00)	0.316	0.565
ΔPEEP(cmH₂O)	2.83±0.94	1.97±0.86	5.340	0.003
NIPPV延迟时间(h)	4.21±1.75	6.12±2.35	－4.842	0.002
夜间主动上调PEEP[n(%)]	61 (65.59)	15 (33.33)	12.757	0.000

血气指标	时　相	观察组(n＝93)	对照组(n＝45)	P值
pH	入院时	7.31±0.05	7.28±0.06	0.018
	72 h	7.36±0.04	7.31±0.05	0.011
PaO₂(mmHg)	入院时	58.66±9.45	56.84±8.73	0.243
	72 h	69.14±8.73	67.34±8.62	0.142
PaCO₂(mmHg)	入院时	58.36±8.13	64.54±9.22	0.000
	72 h	49.36±6.54	56.87±8.03	0.000
miniSpO₂(%)	入院时	86.12±4.35	85.41±4.56	0.517
	72 h	91.85±3.63	89.25±3.94	0.028

血气指标	时　相	观察组(n＝93)	对照组(n＝45)	P值
pH	入院时	7.31±0.05	7.28±0.06	0.018
	72 h	7.36±0.04	7.31±0.05	0.011
PaO₂(mmHg)	入院时	58.66±9.45	56.84±8.73	0.243
	72 h	69.14±8.73	67.34±8.62	0.142
PaCO₂(mmHg)	入院时	58.36±8.13	64.54±9.22	0.000
	72 h	49.36±6.54	56.87±8.03	0.000
miniSpO₂(%)	入院时	86.12±4.35	85.41±4.56	0.517
	72 h	91.85±3.63	89.25±3.94	0.028

临床指标	观察组(n＝93)	对照组(n＝45)	t值	P值
睡眠效率(%)	84.67±6.76	77.95±8.23	4.756	0.004
AHI(次/1 h)	10.34±4.85	17.96±5.35	－8.084	0.002
miniSpO₂(%)	86.76±5.13	80.32±6.44	5.868	0.003
ESS评分	7.23±2.85	10.52±3.14	－5.943	0.005
Borg评分	2.93±0.85	4.15±1.03	－6.888	0.003
HRQL评分	81.64±5.96	75.24±6.33	5.674	0.007

Please choose a citation manager

Content to export