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[1]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,2021,(02):146-151.[doi:10.3877/cma.j.issn.1674-6902.2021.02.003]
　Li Fei,Zhang Chen,Dou Ruiyu,et al.Association of obstructive sleep apnea with the severity of cardiopulmonary impairment in patients with interstitial lung disease[J].,2021,(02):146-151.[doi:10.3877/cma.j.issn.1674-6902.2021.02.003]
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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(PDF)

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2021年02期
页码:
146-151
栏目:
论著
出版日期:
2021-04-20

文章信息/Info

Title:
Association of obstructive sleep apnea with the severity of cardiopulmonary impairment in patients with interstitial lung disease
作者:
李 菲1 张 臣2 窦瑞雨2 谢 江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1、影像科2
Author(s):
Li Fei1;  Zhang Chen2;  Dou Ruiyu2;  Xie Jiang1.
1Department of Pulmonary and Critical Care Medicine, 2Department of Radiology and Imaging, Beijing An-Zhen Hospital, Capital Medical University, Beijing 100029, China
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
Keywords:
Obstructive sleep apnea hypopnea syndrome;  Intermittent hypoxia;  Interstitial lung disease
分类号:
R563
DOI:
10.3877/cma.j.issn.1674-6902.2021.02.003
摘要:
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。
Abstract:
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.

参考文献/References:

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.

备注/Memo

备注/Memo:
基金项目: 国家自然科学基金面上项目(81970079)
通信作者: 谢 江, Email: Frank782008@aliyun.com
更新日期/Last Update: 2021-04-20