摘要
目的:通过分析阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)合并间质性肺疾病(interstitial lung diseases,ILD)患者的临床资料,揭示OSA与ILD患者病情严重程度的关联,评估睡眠参数对ILD患者预后的影响.方法:回顾性收集2011年2月至2021年2月,于北京安贞医院呼吸与危重症医学科完成睡眠监测的ILD患者,定义呼吸暂停低通气指数≥15次/h为OSA.所有患者均完成超声心动图,以三尖瓣反流峰值流速＞3.4m/s或2.9～3.4m/s伴右心室增大伴室壁增厚,且主肺动脉直径＞25mm、右心室/左心室横径＞1作为判断肺动脉高压(hypertension,PH)的标准.通过阅读病历和电话回访的方式确定患者预后状况.结果:全部61例ILD患者,30例合并OSA,OSA组患者BMI 高于非 OSA 组患者[(28.1±2.5)vs.(26.1±3.0)kg/m2,P=0.008],最低血氧饱和度(lowest blood oxygen saturation,LSpO2)显著低于非 OSA 患者[(79.2±7.5)％vs.(83.6±3.9)％,P=0.008],但睡眠血氧饱和度低于90％的时间占总睡眠时间的比例(90％in the total sleep time,TST90)两组间差异无统计学意义.二元Logistic回归单因素分析结果显示,清醒状态PaO2、肺间质病变程度、TST90、LSpO2与ILD患者发生PH相关.多因素分析后,TST90 ≥ 20％仍是ILD患者合并 PH 的独立相关因素(OR=9.460,95％CI:2.093～42.749,P=0.004).Kaplan-Meier 生存分析显示,未合并PH的ILD患者总体生存状况显著优于合并PH的ILD患者(x2=5.150,P=0.023),TST90＜20％的患者总体生存状况显著优于TST90≥20％的患者(x2=5.728,P=0.017).Cox回归模型显示 TST90 ≥ 20％的 ILD 患者死亡风险高于 TST90＜20％者(HR=3.263,95％CI:1.171～9.093,P=0.024),在矫正年龄、性别等混杂因素后仍显著(HR=3.862,95％CI:1.075～13.873,P=0.038).结论:睡眠呼吸暂停所致的夜间低氧与ILD患者PH的发生独立相关,并显著增加ILD患者的死亡风险,易于监测的夜间间歇低氧可能是评估ILD患者病情和判断预后的有效指标.
Abstract
Objective:To investigate the prognostic impact of obstructive sleep apnea(OSA)upon patients with interstitial lung diseases(ILD),and toevaluate the effect of sleep parameters on the prognosis of ILD patients.Methods:ILD patients who completed sleep monitoring in Beijing Anzhen Hospital from February 2011 to February 2021 were retrospectively collected,and OSA was defined as apnea-hypopnea index ≥ 15 times/hour.Echocardiography was completed in all patients,with peak tricuspid regurgitation velocity(TRV)＞3.4m/s or TRV 2.9-3.4m/s complicated with right ventricular enlargement and wall thickening,and main pulmonary artery diameter＞25mm,ratio of right ventricle and left ventricular transverse diameter＞1 as the criterion for pulmonary hypertension(PH).The patients'prognosis was determined via case readings and telephone interviews.Results:Among all 61 ILD patients included,30 were overlapped with OSA.The BMI of the OSA group was higher than that of the non-OSA group[(28.1±2.5)vs.(26.1±3.0)kg/m2,P=0.008],and the lowest blood oxygen saturation(LSpO2)was significantly lower than that of non-OSA group[(79.2±7.5)％vs.(83.6±3.9)％,P=0.008].Univariate analysis showed that PaO2,the severity of interstitial lung disease,the proportion of the time when the sleep oxygen saturation was lower than 90％in the total sleep time(TST90),and LSpO2 were related to the occurrence of PH in patients with ILD.Multivariate analysis showed that TST90 ≥ 20％retained to be an independent correlative factor for occurrence of PH(OR=9.460,95％CI:2.093-42.749,P=0.004).Kaplan-Meier survival analysis showed that the overall survival of ILD patients without PH was significantly better than that of ILD patients with PH(x2=5.150,P=0.023),and the overall survival of patients with TST90＜20％was superior to that of patients with TST90 ≥ 20％patients(x2=728,P=0.017).Cox regression model showed that ILD patients with TST90 ≥ 20％had a higher mortality risk than those with TST90＜20％(HR=3.263,95％CI:1.171-9.093,P=0.024)with significance persisting after confounding factors,i.e.,age and genderwere adjusted for(HR=3.862,95％CI:1.075-13.873,P=0.038).Conclusions:Nocturnal hypoxia caused by sleep apnea is independently associated with the occurrence of PH in patients with ILD,and it significantly increases the risk of fatality in this cohort.Intermittent nocturnal hypoxia,a readily available index,may be an effective indicator for evaluating current condition and prognosis predicting.
维普
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