天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (1): 39-42.doi: 10.11958/20160823

• 临床研究 • 上一篇    下一篇

特发性肺间质纤维化患者中睡眠呼吸紊乱疾病的临床分析

马燕燕， 曹洁,王彦， 李莲， 周宁， 王杰， 智晴晴   

  1. 天津医科大学总医院呼吸科 （邮编 300052）
  • 收稿日期:2016-08-11 修回日期:2016-11-03 出版日期:2017-01-15 发布日期:2017-01-15

sleep apnea, obstructive|pulmonary fibrosis|anoxia|respiratory function tests| idiopathic pulmonary fibrosis|polysomnography| nocturnal hypoxemia

MA Yan-yan, CAO Jie△, WANG Yan, LI Lian, ZHOU Ning, WANG Jie, ZHI Qing-qing   

  1. Department of Respiratory Medicine, Tianjin Medical University General Hospital , Tianjin 300052, China
  • Received:2016-08-11 Revised:2016-11-03 Published:2017-01-15 Online:2017-01-15

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摘要： 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 （SpO2） 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 SpO2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。

关键词: 睡眠呼吸暂停, 阻塞性, 肺纤维化, 缺氧, 呼吸功能试验, 特发性肺间质纤维化, 多导睡眠监测, 夜间低氧 血症

Abstract: Abstract：Objective To observe the incidence and clinical feature of sleep-related breathing disorder in patients with 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 of apnea hypoventilation index (AHI), patients were divided into pure IPF group (AHI＜5 events/h, n=7) and IPF combined with obstructive sleep apnea hypopnea syndrome (IPF + OSAHS) group (AHI≥5 events/h, n=27). The PSG reports of two groups were analyzed, and the correlation between AHI and pulmonary function and oxygen saturation in sleep and at wake were analyzed. Results (1)Thirty-four IPF patients were all demonstrated sleep disorders, low sleep efficiency, increased proportion of stage Ⅰ and stage Ⅱ and decreased proportion of stage Ⅲ and rapid eye movement (REM). The arousal index and the proportion of stage Ⅰ and stage Ⅱ were higher in IPF+OSAHS group than those of pure IPF group (P＜0.01), while the proportion of stage Ⅲ was lower in IPF+OSAHS group than that of pure IPF group (P＜0.01). There was no significant difference in stage REM between two groups. (2)Twenty- seven patients (79% ) combined with OSAHS, among which five subjects (15%) were mild OSAHS with 5 events/h≤AHI＜15 events/h, and 22 subjects (65%) were moderate-severe with AHI≥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 group than those of pure IPF group (P＜0.05). (4)The AHI was positively correlated with body mass index (r=0.791, P＜0.05), and was negatively correlated with forced vital capacity (FVC% pred) (r=- 0.574, P＜0.05) and forced expiratory volume in 1 second (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 produce negative effect on daily life. We should initiate active treatment in patients with sleep-related breathing disorders.

Key words: sleep apnea, obstructive, pulmonary fibrosis, anoxia, respiratory function tests, idiopathic pulmonary fibrosis, polysomnography, nocturnal hypoxemia