重叠综合征OverlapSyndrome.ppt

重叠综合征Overlap Syndrome 王洪冰 参考文献 1.Update on obstructive sleep apnea and its relation to COPD .Int J Chron Obstruct Pulmon Dis. 2014; 9: 349–362 2.Sleep-Disordered Breathing and COPD: The Overlap Syndrome. Respir Care. 2010 October ; 55(10): 1333–1346. 重叠综合征 患病率：OSA 2-4% COPD No 4死因-美国 OS： unknown Flenley认为许多呼吸系统疾病可以overlap。OSA+COPD=overlap并不是最理想的定义。因为COPD和OSA都各有严重程度谱，我们并不知道哪种程度的结合可出现临床意义。如重度COPD加轻OSA与轻度COPD加重度OSA是否可以同等地评价和治疗。 approximately 11% OSA patients have airflow limitation on spirometry Another study in a Veterans Administration population found the prevalence of the overlap syndrome to be 29% 症状有重叠 OSA prevalence 20% north Am. ♀10% Obesity, less risky after 70yrs 53% difficulty initiating or maintaining sleep, 23% excessive daytime sleepiness. 睡眠与通气 In normals, minute ventilation drops from wakefulness to non-REM sleep, and drops further during REM sleep (about 15%, compared to the awake value).——潮气量降低 Beker测量了正常人和COPD患者在清醒、NREN、REM中的分钟通气量，发现COPD患者的从清醒时到NREM时降低了16%，到REM时降低了32%，主要时由于潮气量的降低。 O’Donoghue等发现高碳酸COPD患者在NREM是分钟通气量降低更加严重。 夜间缺氧 desaturation nadir 运动极点时 falling an average of 6 ± 4% 睡眠时 13 ± 9% during sleep Flenley认为导致夜间缺氧的机制有三：低肺泡通气、V/Q降低、呼气末肺容量降低。 Perhaps most clinically relevant, nocturnal oxygen desaturation is a marker of increased mortality in COPD. Even without any upper-airway contribution, various studies have reported that 27–70% of patients with COPD with awake oxygen saturation of 90 –95% can experience substantial desaturation at night, particularly during REM sleep。 OS与夜间缺氧 OS有双重因素致夜间缺氧。 OS夜间缺氧时间更长于单纯OSA；阻塞程度与长期低氧相关。与单纯OSA相比，合并COPD使缺氧更长，也增加死亡率。 肺动脉高压 Acutely, nocturnal oxygen desaturation causes surges in both systemic and pulmonary blood pressure. It now seems likely that repetitive, transient oxygen desaturation can cause pulmonary hypertension.These consequences might help explain why noctu