摘要
目的研究特发性肺间质纤维化(IPF)患者中睡眠呼吸紊乱的发病情况及临床特点。方法收集我院呼吸内科收治的行多导睡眠监测(PSG)的IPF患者34例,根据睡眠呼吸暂停低通气指数(AHI)分为单纯IPF组(AHI<5次/h,7例)与IPF合并睡眠呼吸暂停低通气综合征(IPF+OSAHS)组(AHI≥5次/h,27例),分析2组患者PSG结果,并对AHI与肺功能指标、夜间与清醒时血氧饱和度(Sp O2)进行相关性分析。结果 (1)34例IPF患者均存在睡眠结构紊乱,睡眠效率降低,微觉醒指数、睡眠分期Ⅰ期和Ⅱ期比例增加,Ⅲ期、快速动眼睡眠期(REM期)比例减少。IPF+OSAHS组的微觉醒指数、睡眠分期Ⅰ期和Ⅱ期比例均高于单纯IPF组(均P<0.01),而Ⅲ期比例低于单纯IPF组(P<0.01),2组REM期比例差异无统计学意义。(2)34例IPF患者中有27例(79%)合并OSAHS,其中轻度OSAHS 5例(15%),中重度OSAHS 22例(65%);睡眠呼吸紊乱以低通气为主,多发生于REM期。(3)34例IPF患者均存在夜间低氧血症,且IPF+OSAHS组的氧减指数(ODI)高于单纯IPF组(P<0.01)。(4)IPF患者的AHI与体质指数(BMI)呈正相关,与用力肺活量占预计值百分比(FVC%pred)、第1秒用力肺活量占预计值百分比(FEV1%pred)呈负相关(r分别为0.791、-0.574、-0.664,P<0.01)。夜间最低血氧饱和度(LSO2)、平均血氧饱和度(MSO2)与清醒时Sp O2呈正相关(r分别为0.421、0.464,P<0.01)。结论 IPF患者存在严重的睡眠结构紊乱及夜间低氧血症,OSAHS的存在会加重上述症状,应积极治疗患者的睡眠呼吸紊乱疾病。
Objective To observe the incidence and clinical feature of sleep-related breathing disorder in patientswith idiopathic pulmonary fibrosis（IPF）. Methods Thirty-four IPF patients who were measured by polysomnography（PSG）were collected in the Department of Respiration of Tianjin Medical University General Hospital. According to the results ofapnea hypoventilation index（AHI）, patients were divided into pure IPF group（AHI〈5 events/h, n=7） and IPF combinedwith obstructive sleep apnea hypopnea syndrome（IPF ＋ OSAHS） group（AHI≥5 events/h, n=27）. The PSG reports of twogroups were analyzed, and the correlation between AHI and pulmonary function and oxygen saturation in sleep and at wakewere analyzed. Results（1）Thirty-four IPF patients were all demonstrated sleep disorders, low sleep efficiency, increasedproportion of stage Ⅰ and stage Ⅱ and decreased proportion of stage Ⅲ and rapid eye movement（REM）. The arousal indexand the proportion of stage Ⅰ and stage Ⅱ were higher in IPF＋OSAHS group than those of pure IPF group（P〈0.01）, whilethe proportion of stage Ⅲ was lower in IPF＋OSAHS group than that of pure IPF group（P〈0.01）. There was no significantdifference in stage REM between two groups.（2）Twenty-seven patients（79%） combined with OSAHS, among which fivesubjects（15%） were mild OSAHS with 5 events/h≤AHI〈15 events/h, and 22 subjects（65%） were moderate-severe withAHI≥15 events/h. The main type of sleep-disorder breathing was hypoventilation, which mainly happened in stage REM.（3）Thirty-four IPF patients showed sleep hypoxemia, and the oxygen desaturation index（ODI） was higher in IPF-OSAHS groupthan those of pure IPF group（P〈0.05）.（4）The AHI was positively correlated with body mass index（r=0.791, P〈0.05）, andwas negatively correlated with forced vital capacity（FVC%pred）（r=-0.574, P〈0.05） and forced expiratory volume in 1second（FEV1%pred） in IPF patients（r=-0.664, P〈0.05）. The lowest oxygen saturation（LSO2） and mean oxygen saturation（MSO2） in sleep were positively related with oxygen saturation at wake（r=0.421 and r=0.464, P〈0.05 respectively）.Conclusion The IPF patients show severe sleep disorder and hypoxemia, which can be worsen by OSAHS and producenegative effect on daily life. We should initiate active treatment in patients with sleep-related breathing disorders.
出处
《天津医药》
CAS
2017年第1期39-43,共5页
Tianjin Medical Journal
基金
国家自然科学基金资助项目(81670084
81500070)
