支气管高反应性在合并哮喘样症状的阻塞性睡眠呼吸暂停患者中的作用
2023/11/23
摘要
背景：阻塞性睡眠呼吸暂停（OSA）是哮喘的主要合并症之一，也是哮喘发作的因素之一。在合并OSA的哮喘患者中，肥胖、腹部脂肪和全身性炎症与其病情的严重程度有关，但支气管高反应性（BHR）的作用尚不清楚。我们研究了在具有OSA和哮喘样症状的患者中，BHR和纵隔脂肪宽度作为腹部脂肪度量的参与情况。
方法：回顾性纳入了接受BHR测试和胸部计算机断层扫描以评估哮喘样症状的OSA患者。我们评估了阻塞性综合征指数（AHI）与PC20或前纵隔脂肪宽度之间的关系，根据是否存在BHR进行分层。
结果：具有BHR的OSA患者（n = 29）与没有BHR的患者（n = 25）相比，显示更明显的气道阻塞，更频繁的低唤醒阈值和更低的纵隔脂肪宽度，而AHI较少。在整体分析中，纵隔脂肪宽度与AHI呈显著正相关，即使在年龄和性别调整后仍然显著。这在没有BHR的患者中尤为显著，而在具有BHR的OSA患者中，呼吸暂停指数与气流受限之间存在显著的负相关，低通气指数与PC20之间也存在显著的负相关。
结论：在合并哮喘样症状的OSA患者中，较大AHI的风险因素取决于是否存在BHR。在存在BHR的情况下，哮喘的严重程度可能决定了伴随的OSA的严重程度。
Role of bronchial hyperresponsiveness in patients with obstructive sleep apnea with asthma-like symptoms
Akiko Sano, Takenori Kozuka, Nanase Watatani, Yuuki Kunita, Yoshiyuki Kawabata, Kyuya Gose, Ken Shirahase, Kazuya Yoshikawa, Ryo Yamazaki, Yusaku Nishikawa, Takashi Omori, Osamu Nishiyama, Takashi Iwanaga, Hiroyuki Sano, Ryuta Haraguchi, Yuji Tohda, Hisako Matsumoto
Abstract
Background: Obstructive sleep apnea (OSA) is one of the major co-morbidities and aggravating factors of asthma. In OSA-complicated asthma, obesity, visceral fat, and systemic inflammation are associated with its severity, but the role of bronchial hyperresponsiveness (BHR) is unclear. We investigated the involvement of BHR and mediastinal fat width, as a measure of visceral fat, with OSA severity in patients with OSA and asthma-like symptoms.
Methods: Patients with OSA who underwent BHR test and chest computed tomography scan for asthma-like symptoms were retrospectively enrolled. We evaluated the relationship between apnea-hypopnea index (AHI) and PC20or anterior mediastinal fat width, stratified by the presence or absence of BHR.
Results: OSA patients with BHR (n = 29) showed more obstructive airways and frequent low arousal threshold and lower mediastinal fat width, and tended to show fewer AHI than those without BHR (n = 25). In the overall analysis, mediastinal fat width was significantly positively correlated with AHI, which was significant even after adjustment with age and gender. This was especially significant in patients without BHR, while in OSA patients with BHR, there were significant negative associations between apnea index and airflow limitation, and hypopnea index and PC20.
Conclusions: Risk factors for greater AHI differed depending on the presence or absence of BHR in OSA patients with asthma-like symptoms. In the presence of BHR, severity of asthma may determine the severity of concomitant OSA.
背景：阻塞性睡眠呼吸暂停（OSA）是哮喘的主要合并症之一，也是哮喘发作的因素之一。在合并OSA的哮喘患者中，肥胖、腹部脂肪和全身性炎症与其病情的严重程度有关，但支气管高反应性（BHR）的作用尚不清楚。我们研究了在具有OSA和哮喘样症状的患者中，BHR和纵隔脂肪宽度作为腹部脂肪度量的参与情况。
方法：回顾性纳入了接受BHR测试和胸部计算机断层扫描以评估哮喘样症状的OSA患者。我们评估了阻塞性综合征指数（AHI）与PC20或前纵隔脂肪宽度之间的关系，根据是否存在BHR进行分层。
结果：具有BHR的OSA患者（n = 29）与没有BHR的患者（n = 25）相比，显示更明显的气道阻塞，更频繁的低唤醒阈值和更低的纵隔脂肪宽度，而AHI较少。在整体分析中，纵隔脂肪宽度与AHI呈显著正相关，即使在年龄和性别调整后仍然显著。这在没有BHR的患者中尤为显著，而在具有BHR的OSA患者中，呼吸暂停指数与气流受限之间存在显著的负相关，低通气指数与PC20之间也存在显著的负相关。
结论：在合并哮喘样症状的OSA患者中，较大AHI的风险因素取决于是否存在BHR。在存在BHR的情况下，哮喘的严重程度可能决定了伴随的OSA的严重程度。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Allergol Int. 2023 Nov 9:S1323-8930(23)00110-7. doi: 10.1016/j.alit.2023.10.006.)
(Allergol Int. 2023 Nov 9:S1323-8930(23)00110-7. doi: 10.1016/j.alit.2023.10.006.)
Role of bronchial hyperresponsiveness in patients with obstructive sleep apnea with asthma-like symptoms
Akiko Sano, Takenori Kozuka, Nanase Watatani, Yuuki Kunita, Yoshiyuki Kawabata, Kyuya Gose, Ken Shirahase, Kazuya Yoshikawa, Ryo Yamazaki, Yusaku Nishikawa, Takashi Omori, Osamu Nishiyama, Takashi Iwanaga, Hiroyuki Sano, Ryuta Haraguchi, Yuji Tohda, Hisako Matsumoto
Abstract
Background: Obstructive sleep apnea (OSA) is one of the major co-morbidities and aggravating factors of asthma. In OSA-complicated asthma, obesity, visceral fat, and systemic inflammation are associated with its severity, but the role of bronchial hyperresponsiveness (BHR) is unclear. We investigated the involvement of BHR and mediastinal fat width, as a measure of visceral fat, with OSA severity in patients with OSA and asthma-like symptoms.
Methods: Patients with OSA who underwent BHR test and chest computed tomography scan for asthma-like symptoms were retrospectively enrolled. We evaluated the relationship between apnea-hypopnea index (AHI) and PC20or anterior mediastinal fat width, stratified by the presence or absence of BHR.
Results: OSA patients with BHR (n = 29) showed more obstructive airways and frequent low arousal threshold and lower mediastinal fat width, and tended to show fewer AHI than those without BHR (n = 25). In the overall analysis, mediastinal fat width was significantly positively correlated with AHI, which was significant even after adjustment with age and gender. This was especially significant in patients without BHR, while in OSA patients with BHR, there were significant negative associations between apnea index and airflow limitation, and hypopnea index and PC20.
Conclusions: Risk factors for greater AHI differed depending on the presence or absence of BHR in OSA patients with asthma-like symptoms. In the presence of BHR, severity of asthma may determine the severity of concomitant OSA.
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生物治疗对重度哮喘患者的临床缓解：英国重度哮喘登记研究的分析
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儿童和青少年哮喘患者鼻上皮基因表达和总IgE
