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第22期 – 慢性阻塞性肺病與阻塞性睡眠窒息症 – 重疊症候群

第22期 – 慢性阻塞性肺病與阻塞性睡眠窒息症 – 重疊症候群  downloading-updates-xxl

 

慢性阻塞性肺病與阻塞性睡眠窒息症:重疊症候群

 

慢性阻塞性肺病(COPD)和阻塞性睡眠窒息症(OSA)是兩大在臨床診療中是最普遍的慢性呼吸系統疾病。這兩種疾病同時出現的情況亦很常見,在1985年時英國學者Flenley稱這種情況為重疊症候群#1。根據最近的流行病學數據顯示,約有1%成年人同時患有這兩種疾病#2,而睡眠窒息症患者當中,有10-20%會出現重疊症候群。#3根據已公佈的全球慢性阻塞性肺病倡議組織訂立的患病階段數據(GOLD1)指出,重疊症候群的患病率有16%,從而估計有4%的男性得此疾病。在睡眠窒息症指數(AHI)每小時最少5次窒息的男性當中,有高達24%會患此症。#2

 

重疊症候群患者會比起只患慢性阻塞性肺病或阻塞性睡眠窒息症的病人會出現更明顯的夜間血含氧量下降和血碳酸過多,導致更易發展成肺高壓和右心室衰竭。#4 學者Bradley和研究人員調查了50個阻塞性睡眠窒息症患者,發現當中約10%證實有右心室衰竭。發展成右心室衰竭的危險因素有日間血氧過少、血碳酸過多和一秒用力呼氣量(FEV1)下降#5#6。臨牀測試亦顯示,即使患有嚴重阻塞性睡眠窒息,但如沒有同時患其他心肺疾病,則不偏向發展成明顯的肺高壓。#7然而,那些同時患阻塞性肺病、日間血氧過少和血碳酸過多的病人,都已被確定有肺高壓的現象。#8除此之外,學者Hawrylkiewicz和研究人員更觀察到有86%的重疊症候群病人出現肺高壓問題,相比下,只有16%的阻塞性睡眠窒息症病人患有肺高壓。#9

 

近年,重疊症候群病人的死亡率數據得到更完善的研究。阻塞性睡眠窒息症已被證實會增加慢性阻塞性肺病病者的死亡率。學者Marin和研究人員探究慢性阻塞性肺病患者與重疊症候群患者,經過超過9年的跟進工作後,他們證實重疊症候群組各種原因的死亡率(42.2%)都較慢性阻塞性肺病組(24.2%)為高。#10即使在慢性阻塞性肺病的嚴重程度作出調整後,合併阻塞性睡眠窒息症仍然是死亡的危險因素。同樣地,確診慢性阻塞性肺病及其他附帶的臨床特徵,如一秒用力呼氣量(FEV1)的下降或吸煙年期,都會增加阻塞性睡眠窒息症患者的死亡率。#11學者Lavie和研究人員已證實慢性阻塞性肺病導致阻塞性睡眠窒息症患者的死亡風險高出7倍之多。#12

 

#1參考文獻:Flenley DC. Sleep in chronic obstructive lung disease. Clin Chest Med. 1985; 6(4):651–661.
#2參考文獻:McNicholas WT. Chronic obstructive pulmonary disease and obstructive sleep apnea: overlaps in pathophysiology, systemic inflammation, and cardiovascular disease. Am J Respir Crit Care Med 2009; 180:692–700.
#3參考文獻: Lopez-Acevedo M, Torres-Palacios A, Elena Ocasio-Tascon M, et al. Overlap syndrome: an indication for sleep studies? Sleep Breath 2009; 13:409–413.
#4參考文獻:Shteinberg M, Weiler-Ravel D, Adir Y. The overlap syndrome: obstructive sleep apnea and chronic obstructive pulmonary disease. Harefuah 2009; 148:333–336.
#5參考文獻:Bradley TD, Rutherford R, Grossman RF, Lue F, Zamel N, Moldofsky H, Phillipson EA. Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis. 1985; 131(6):835–839.
#6參考文獻:Bradley TD, Rutherford R, Lue F, Moldofsky H, Grossman RF, Zamel N, Phillipson EA. Role of diffuse airway obstruction in the hypercapnia of obstructive sleep apnea. Am Rev Respir Dis. 1986; 134(5):920–924.
#7參考文獻:Arias MA, Garcia-Rio F, Alonso-Fernandez A, Martinez I, Villamor J. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur Heart J. 2006; 27(9):1106–1113.
#8參考文獻: Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest. 1996; 109(2):380–386.
#9參考文獻:Hawrylkiewicz I, Sliwinski P, Gorecka D, Plywaczewski R, Zielinski J. Pulmonary haemodynamics in patients with OSAS or an overlap syndrome. Monaldi Arch Chest Dis. 2004;61(3):148–152.
#10參考文獻:Marin JM, Soriano JB, Carrizo SJ, Boldova A, Celli BR. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med. 2010; 182(3):325–331.
#11參考文獻:Chaouat A, Weitzenblum E, Krieger J, Krieger J, Sforza E, Hammad H, Oswald M, Kessler R. Prognostic value of lung function and pulmonary haemodynamics in OSA patients treated with CPAP. Eur Respir J. 1999; 13(5):1091–1096.
#12參考文獻:Lavie P, Herer P, Lavie L. Mortality risk factors in sleep apnoea: a matched case-control study. J Sleep Res. 2007; 16(1):128–134.
#13 參考文獻: “COPD and Obstructive Sleep Apnea (OSA): The overlap syndrome”by Aggelos S. Aggelakas MD, PhD (cand.), 20th November 2012

 

 

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