Analysis of clinical characteristics of obstructive sleep apnea hypopnea syndrome complicated and chronic obstructive pulmonary disease with the emphysematous phenotype

Abstract:

Objective To study the clinical characteristics and influencing factors of obstructive sleep apnea hypopnea syndrome （OSAHS） and chronic obstructive pulmonary disease（COPD） with the emphysematous phenotype，namely COPD-OSAHS overlap syndrome，so as to provide understanding and guidance for clinical practice.Methods A retrospective case-control study was conducted on 301 patients with OSAHS admitted to The Second Affiliated Hospital of Kunming Medical University from March 2015 to June 2022. The COPD-OSAHS overlap syndrome group was divided into two groups：COPD patients with the emphysematous phenotype and non-emphysematous phenotype according to Goddard's classification criteria. The demographic data，pulmonary function，night polysomnography monitoring indexes，chest imaging parameters，complications，and other characteristics were compared separately. Partial correlation analysis and logistic regression were used to analyze the influencing factors of OSAHS with COPD with the emphysematous phenotype.Results There were statistically significant differences in sex，smoking，dyspnea，BMI，apnea hypopnea index（AHI），Infiltrated% and Collapsed% in the COPD-OSAHS overlap syndrome with emphysematous phenotype patients compared with the simple OSAHS group and non-emphysematous phenotype group（all P<0.05）. And pulmonary artery pressure，TS₈₅ and oxygen desaturation index（ODI） between COPD-OSAHS overlap syndrome patients with emphysematous phenotype and non-emphysematous phenotype were statistically significant（all P<0.05）. The incidence of pulmonary heart disease，atrial fibrillation and lower limb edema was higher in COPD-OSAHS overlap syndrome patients with non-emphysematous phenotype group. The results of correlation analysis showed that BMI，smoking index，AHI，TS₈₅，ODI，Infiltrated%，Collapsed% were negatively correlated with LAA%（r =-0.434，-0.254，-0.439，-0.327，-0.336，-0.756，-0.609），with statistical significance（all P<0.05）. In the logistic regression analysis of the related factors of COPD patients with emphysematous phenotype and OSAHS patients，BMI（OR=0.891，95%CI=0.807-0.984），AHI（OR=0.948，95%CI=0.918-0.979），Collapsed%（OR=0.406，95%CI=0.265-0.623） were the main influencing factors（all P<0.05）.Conclusion Compared with the simple OSAHS group and non-emphysematous phenotype group，COPD-OSAHS overlap syndrome with emphysematous phenotype patients have a larger proportion of males，smoking，dyspnea，lower index of BMI and AHI，less collapse% in both lungs，and higher pulmonary artery pressure，more cough and expectoration，more complicated with pulmonary heart disease，atrial fibrillation，lower limb edema and longer hypoxia time in COPD-OSAHS overlap syndrome with non-emphysematous phenotype compared with simple OSAHS. And BMI，AHI and Collapsed% are the main influencing factors in patients with COPD with the emphysematous phenotype and OSAHS.