目的:评价中强度有氧训练对慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)-阻塞性睡眠呼吸暂停(obstructive sleep apnea，OSA)重叠综合征患者的康复疗效。方法:采用回顾性队列研究，选取2021年1月至2023年10月上海市第四康复医院诊断为COPD-OSA重叠综合征并应用气道正压通气(positive airway pres-sure，PAP)的患者。29例干预组完成中强度有氧训练20周，并选择同期相匹配单纯应用PAP的患者29例作为对照组。比较2组患者治疗前后在运动功能、日常生活能力、体成分、呼吸功能、心理状态及睡眠参数方面的差异。结果:20周后与治疗前比较，干预组患者6 min步行距离[(268。62±47。02)m比(316。97±58。44)m]、伸膝肌肌力[22。40(20。40，27。45)kg比25。40(20。00，30。45)kg]、Barthel指数[(66。03±12。42)比(76。72±11。82)]均显著提高，5次起坐测试时间[19。50(15。94，31。10)s比13。50(11。75，18。50)s]、体质量指数[(25。16±3。17)kg/m2 比(22。31±2。16)kg/m2]及脂肪质量[(24。13±9。22)kg比(20。47±8。32)kg]降低，PSG参数、血气分析、汉密尔顿抑郁及焦虑量表评分均明显改善(均P＜0。05);对照组伸膝肌肌力、改良英国医学研究委员会(Medical Research Council，MRC)呼吸困难分级量表评分、PSG参数及心理状态改善，而脂肪质量增加(均P<0。05)。组间比较，干预组6 min步行距离[(316。97±58。44)m比(239。93±37。80)m]、伸膝肌肌力[25。40(20。00，30。45)kg比23。70(20。50，25。60)kg]、5次起坐测试时间[13。50(11。75，18。50)s比19。50(17。60，23。12)s]、Barthel指数[(76。72±11。82)比(67。59±10。74)]、改良英国MRC呼吸困难分级量表评分、pH值、动脉血氧分压、血氧饱和度＜90%占总睡眠时间百分比[3。00(2。60，4。45)%比 4。00(3。30，6。30)%]、体质量指数[(22。31±2。16)kg/m2比(26。17±3。83)kg/m2]、脂肪质量、汉密尔顿抑郁及焦虑量表评分均显著优于对照组(P＜0。05)，而第 1 秒用力呼气量(forced expiratory volume in one second，FEV1)占预计值百分比(43。72%±9。49%比 43。97%±7。22%)、动脉血二氧化碳分压、呼吸暂停低通气指数、夜间最低血氧饱和度及去脂质量、去脂质量指数差异无统计学意义(均P>0。05)。结论:20周的中强度有氧训练对应用PAP的COPD-OSA重叠综合征患者可明显增强其运动功能、降低体脂，改善缺氧、呼吸困难及心理状态，进一步提高日常生活能力，可能是此类患者适宜的康复方案。
Rehabilitation efficacy of aerobic exercise on patients with overlap syndrome of chronic obstructive pulmonary disease and obstructive sleep apnea
Objective To evaluate the rehabilitation efficacy of moderate intensity aerobic exercise on patients with chronic obstructive pulmonary disease(COPD)-obstructive sleep apnea(OSA)overlap syndrome.Methods A retrospective cohort study was used in the study.The patients who were diagnosed with COPD-OSA overlap syndrome and applied positive airway pressure(PAP)from January 2021 to December 2023 were selected in the Department of Respiratory Rehabilitation,at the Fourth Rehabilitation Hospital of Shanghai.A total of 29 patients[aged(62.2±5.9)years,male 65.5%]with overlap syndrome received moderate intensity aerobic training for 20 weeks were enrolled as the intervention group(IG).At the same time,29 patients[(64.6±6.9)years,male 62.1%]with overlap syndrome who didn't receive aerobic training were selected as the control group(CG).The differences in motor function,daily living abilities,body composition,respiratory function,psychological state and sleep parameters between two cohorts of patients before and after treatment were compared.Results After 20 weeks of aerobic exercise,the various parameters of IG demonstrated significant improvement compared with those before treatment:a notable increase in the 6 min walk distance(6MWD)[(268.62±47.02)m vs(316.97±58.44)m],quadriceps muscle strength[22.40(20.40,27.45)kg vs 25.40(20.00,30.45)kg],Barthel index(BI)scores[(66.03±12.42)vs(76.72±11.82)],a reduction in the 5 times sit-to-stand test(5TSTS)[19.50(15.94,31.10)s vs 13.50(11.75,18.50)s],body mass index(BMI)[(25.16±3.17)kg/m2 vs(22.31±2.16)kg/m2]and fat mass(FM)[(24.13±9.22)kg vs(20.47±8.32)kg].Additionally,there were significant enhancements observed in PSG parameters,blood gas analysis results,Hamilton depression scale(HAMD)and Hamilton anxiety scale(HAMA)scores after training in IG(all P<0.05).In contrast,the CG exhibited improvements in quadriceps muscle strength and the modified Medical Research Council(mMRC)as well as PSG parameters and psychological state;while there was an FM increase in this group(all P<0.05).Compared with the CG,the 6MWD[(316.97±58.44)m vs 239.93±37.80)m],quadriceps muscle strength[25.40(20.00,30.45)kg vs 23.70(20.50,25.60)kg],5TSTS[13.50(11.75,18.50)s vs 19.50(17.60,23.12)s],BI[(76.72±11.82)vs(67.59±10.74)],mMRC,pH,PaO2,TS90%,BMI[(22.31±2.16)kg/m2 vs(26.17±3.83)kg/m2],FM,HAMD,HAMA of the IG patients showed significant improvement(all P＜0.05).However,there were no significant differences observed between the two groups in terms of percentage of predicted forced expiratory volume in one second(FEV1%)(43.72%±9.49%vs 43.97%±7.22%),PaCO2,apnea hypopnea index,pulse oxygen saturation(L-SpO2)%,fat free mass and fat free mass index(P>0.05).Conclusions The combination of a 20-week moderate-intensity aerobic training and PAP demonstrates significant improvements in motor function,reduction in body fat,alleviation of hypoxia and respiratory difficulties,enhancement of psychological state and daily life abilities.This intervention may be considered suitable for patients with COPD-OSA overlap syndrome.
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