Clinical Characteristics And TCM Syndromes Of Chronic Obstructive Pulmonary Disease Complicated With Obstructive Sleep Apnea

BackgroundChronic Obstructive Pulmonary Disease(COPD)ranks as the 6th leading cause of disability-adjusted annual loss of life worldwide,and has become the 3rd leading cause of human death worldwide in 2020,with high morbidity,disability and mortality characteristics.Obstructive Sleep Apnea(OSA)is one of the important comorbidities of COPD,which affects the pathological changes of COPD,airway inflammation and systemic inflammation,frequency of COPD acute exacerbation hospitalization,treatment choice and prognosis.The impact of OSA with different BMI on pulmonary function,blood gas analysis and polysomnography in COPD patients is still unclear.Objective(1)To explore the clinical characteristics of patients with COPD combined with OSA;(2)To investigate the effects of different BMI indices on patients with COPD combined with OSA;(3)To observe the distribution of TCM evidence of COPD combined with OSA.MethodsIn this study,we applied a cross-sectional study method to collect patients diagnosed with COPD from December 2020 to December 2022 at Xiyuan Hospital,Chinese Academy of Traditional Chinese Medicine,and divided them into COPD with OSA group(i.e.,OSA group)and COPD without OSA group(i.e.,non-OSA group)according to whether they were combined with OSA,and collected their clinical data,including medical history data,pulmonary function test,polysomnography The clinical data,including medical history,pulmonary function tests,polysomnography,etc.,were collected,and the "COPD-OSA Chinese Medicine Symptom Questionnaire" and "Symptom-Evidence Score Correspondence Scale"were completed,entered into an Excel sheet,and statistically analyzed using SPSS 25.0 software.Results(1)151 COPD cases were included,including 71 patients with combined OSA,and the prevalence of OSA in COPD population was 47.02%;among patients with COPD grade 1,the prevalence of OSA was 53.33%;among patients with COPD grade 2,the prevalence of OSA was 53.62%;among patients with COPD grade 3,the prevalence of OSA was 34.62%.(2)Compared with the non-OS A group,patients in the COPD combined with OSA group had a higher prevalence of hypertension(P<0.01),a higher BMI(P<0.05),and a higher proportion of obesity(P<0.05).(3)Compared with the non-OS A group,patients in the COPD combined with OSA group had more acute exacerbations in the previous year(P<0.01),higher CAT scores(P<0.05),and poorer quality of life.(4)There was no statistically significant difference in pulmonary function FVC/pre,FEV1/pre,and FEV1/FVC between patients in the non-OS A group and the OSA group(P>0.05).(5)Compared with the non-OS A group,patients in the COPD combined with OSA group had lower minimum nocturnal oxygen saturation(P<0.01),more diagnosed hypoxemia(P<0.01),lower partial pressure of oxygen on blood gas analysis(P<0.05),and more severe hypoxic conditions;patients in the OSA group had higher levels of TNF-α inflammatory factor(P<0.05),and combined OSA may The combination of OSA may aggravate the level of inflammation in COPD patients.(6)The results of binary logistic regression model analysis showed that high BMI and low LSpO2 were the risk factors for the combination of OSA in COPD patients.(7)The results of Person correlation coefficient analysis showed that in COPD patients without combined OSA,there was a positive correlation between BMI index and pulmonary function FEV1/pre and FEV1/FVC levels(r=-0.354,0.248;P<0.01,P<0.05),and the level of pulmonary function was worse in COPD patients as BMI index decreased.In patients with COPD combined with OSA,there was a negative correlation between BMI and pulmonary function FEV1/pre levels(r=-0.346,P<0.01),and high BMI aggravated pulmonary impairment in COPD patients;there was a negative correlation between BMI and LSpO2(r=0.342,P<0.01),and a positive correlation between BMI and PaCO2(r=0.247,P<0.05),i.e.,nocturnal hypoxia and carbon dioxide retention in patients with COPD combined with OSA gradually increased with increasing BMI.(8)In the obese population,patients in the OSA group had lower pulmonary function FEV1/pre(P<0.01),lower LSpO2(P<0.01),and a higher percentage of hypoxemia(P<0.01)than patients in the non-OSA group,and patients in the OSA group had worse pulmonary function and more severe hypoxia.(9)In the normal or overweight population,patients in the OSA group had higher levels of pulmonary function FEV1/pre(P<0.01)and FEV1/FVC(P<0.01),lower LSpO2(P<0.01),and a higher proportion of hypoxemia(P<0.01)than patients in the non-OSA group,and patients in the OSA group had better pulmonary function than patients in the nonOSA group,but still had worse degree of nocturnal hypoxia.(10)In patients with COPD combined with OSA,patients in the obese group had a higher rate of hypertension diagnosis(P<0.01),the presence of lower FEV1/pre,FEV1/FVC levels(P<0,01),higher PaCO2(P<0.01),lower PaO2(P<0.01),higher AHI,ODI(P<0.05),lower LSpO2(P<0.01),and a greater percentage of hypoxemia(P<0.01).(11)In COPD patients,the evidence elements involving real pathology mainly include phlegm,heat,dampness,drinking,cold,qi stagnation and blood stasis,and those involving deficiency pathology mainly include qi deficiency,yang deficiency and yin deficiency,and the disease locations are mainly in the lung,spleen and kidney.(12)In terms of the distribution of the evidence elements of the actual nature,patients in the OSA group had more frequent distribution of blood stasis evidence elements(P<0.05)and less distribution of cold evidence elements(P<0.05)than patients in the non-OSA group;in terms of the distribution of the evidence elements of the deficiency nature,there was no statistically significant difference in the distribution of the evidence elements of qi deficiency,yang deficiency and yin deficiency between the two groups(P>0.05);in terms of the distribution of the evidence elements of the disease location,patients in the OSA group had more distribution of the evidence elements of the disease location than patients in the non-OSA group In terms of distribution of evidence elements of disease locations,patients in the OSA group had more distribution of spleen evidence elements(P<0.01)and less distribution of lung evidence elements(P<0.01);in terms of distribution of evidence types,patients in the non-OS A group had more evidence types of deficiency evidence than those in the OS A group(P<0.05).(13)Evidence correlation analysis showed that the risk of producing blood stasis evidence was 6.219 times higher in COPD combined with OS A(P<0.01),and the risk of disease location shifting from lung to other sites was 0.145 times higher(P<0.01);the frequency of cold evidence in COPD combined with OSA patients decreased with higher BMI(P<0.01).Conclusion(1)151 COPD cases were included,including 71 patients with combined OSA,and the prevalence of OSA in the COPD population was 47.02%;in patients with COPD grade 1,the prevalence of OSA was 53.33%;in patients with COPD grade 2,the prevalence of OSA was 53.62%;in patients with COPD grade 3,the prevalence of OSA was 34.62%.(2)The combination of OSA increases the prevalence of hypertension in COPD patients,increases their annual hospitalization for acute exacerbations,increases their level of inflammation,makes hypoxia more severe,and makes their quality of life worse.(3)Compared with COPD patients without OSA,COPD patients with OSA have higher BMI and a higher percentage of obesity;high BMI and low LSpO2 are risk factors for COPD patients with OSA.(4)In COPD patients without OSA,BMI was linearly correlated with pulmonary function FEV1/pre and FEV1/FVC,and COPD patients had worse pulmonary function as BMI decreased;in COPD patients with OSA,BMI was linearly correlated with pulmonary function FEV1/pre,LSpO2,and PaCO2,and pulmonary function was worse as BMI increased.COPD combined with OSA patients had poorer lung function,more significant nocturnal hypoxia,and more severe carbon dioxide retention.(5)In pulmonary function,the difference between COPD patients with combined OSA and those without combined OSA was not significant;however,in the obese population,COPD patients with combined OSA had worse pulmonary function than those without combined OSA;in the normal or overweight population,COPD patients with combined OSA had better pulmonary function and worse nocturnal hypoxia than those without combined OSA.(6)In COPD patients,the evidence involving real pathology mainly includes phlegm,heat,dampness,drinking,cold,qi stagnation,blood stasis,etc.,and the evidence involving deficiency pathology mainly includes qi deficiency,yang deficiency,yin deficiency,etc.,and the disease sites are mainly in the lung,spleen,and kidney.Compared with COPD patients without OSA,COPD patients with OSA had more frequent blood stasis evidence,less cold evidence,and more frequent disease location in the spleen,and the evidence type was mainly mixed with deficiency and actual evidence.As the BMI increased,the symptoms related to cold evidence elements were less in COPD patients with OSA.