Clinical Observation Of Acute Exacerbation Of Chronic Obstructive Pulmonary Disease With Obstructive Sleep Apnea Hypopnea Syndrome

Objective By observing the effect of acute exacerbation of chronic obstructive pulmonary disease with obstructive sleep apnea hypopnea syndrome（overlap syndrome）on circulatory system and metabolism and the clinical characteristics of overlap syndrome with pulmonary hypertension,it is suggested that clinician should pay attention to and reduce the occurrence of complication.Methods From March2019 to February 2020,58 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to the respiratory and critical care department of Tianjin Medical University General Hospital were selected.According to the combination of obstructive sleep apnea hypopnea syndrome or not,they were divided into the overlap syndrome group（observation group）and the simple COPD group（control group）.According to the existence of pulmonary hypertension,the overlap syndrome group was divided into the overlap syndrome with pulmonary hypertension group（observation group）and the simple overlap syndrome group（control group）.The demographic and history data,symptoms and signs,laboratory indexes（daytime arterial blood gas analysis,blood routine,fasting blood glucose,blood lipid,B-type natriuretic peptide）,polysomnography,echocardiography and pulmonary function results were collected.Result There were 58 patients in acute exacerbation stage of COPD,including 42 patients with overlap syndrome and 20 patients with overlap syndrome and pulmonary hypertension.The neck circumference,the frequency of acute exacerbation of COPD,the incidence of hypertension and pulmonary hypertension,the concentration of B-type natriuretic peptide,fasting blood glucose,total cholesterol,triglyceride and low density lipoprotein in the overlap syndrome group were significantly higher than those in the COPD group（P<0.05）;the concentration of high density lipoprotein was lower than that of COPD group（P<0.05）;there were no significant differences in gender,age,smoking history,height,weight,BMI,COPD severity,coronary heart disease and cerebrovascular disease（P>0.05）.The smoking index,Epworth score,daytime arterial blood CO₂ partial pressure,red blood cell count,hemoglobin content,red blood cell specific volume,apnea hypopnea index,oxygen reduction index and Sp O₂ less than 90%time in the overlap syndrome with pulmonary hypertension group were significantly higher than those in the overlap syndrome group（P<0.05）;there were statistically significant differences in daytime arterial blood O₂ partial pressure,1 second forced expiratory volume,forced vital capacity,1 second rate,the percentage of predicted value of the FEV₁,the lowest blood oxygen saturation and the average blood oxygen saturation in polysomnography between the patients in the overlap syndrome group and the patients in the overlap syndrome group（P<0.05）,but there were no statistically significant differences in gender and age（P>0.05）.Conclusion The incidence of overlap syndrome was 72.4%in patients with acute exacerbation of COPD and 47.6%in patients with overlap syndrome and pulmonary hypertension.Patients with overlap syndrome have larger neck circumference,increased frequency of acute exacerbation of COPD,increased incidence of hypertension and pulmonary hypertension,more obvious cardiac dysfunction,and disorder of blood glucose and lipid metabolism.Patients with overlap syndrome and pulmonary hypertension have more severe daily hypoxia and intermittent hypoxia.Lung function impairment is more serious,carbon dioxide retention is more obvious,blood viscosity increases,and these factors accelerate the formation of pulmonary hypertension.