成人阻塞性睡眠呼吸暂停风险与哮喘控制的相关性
2011/04/15
背景：尽管给予最佳治疗，未被识别的阻塞性睡眠呼吸暂停（obstructive sleep apnea, OSA）可能会导致差的哮喘控制。我们的目的是，评价OSA风险和成年人哮喘控制的关系。
方法：在三级保健门诊常规就诊的哮喘病人，完成睡眠障碍问卷的睡眠呼吸暂停表(sleep apnea scale of the sleep disorders questionnaire, SA-SDQ)和哮喘控制调查问卷(asthma control questionnaire, ACQ)。ACQ≥1.5分被定义为哮喘未良好控制，而男性SA-SDQ评分≥36分或女性SA-SDQ评分≥32分被定义为高OSA风险。Logistic回归分析被用来建立高OSA风险与哮喘未良好控制（ACQ完整版和简化版）的相关性模型。
结果：在472例哮喘受试者中，完整版ACQ分数为0.87±0.90，其中80例（17%）受试者为哮喘未良好控制。SA-SDQ分数是27±7，其中109例（23%)受试者符合高OSA风险的定义。通过校正肥胖和其它已知使哮喘控制恶化的因素后，高OSA风险与哮喘未良好控制(ACQ完整版)相关（OR=2.87, 95%CI=[1.54, 5.32], P=0.0009)。当采用简化版ACQ时，亦可见相似的独立关联性。
结论：高OSA风险与哮喘未良好控制显著相关，不依赖于加重哮喘的因素，且与使用的ACQ版本无关。难以获得哮喘良好控制的患者，应筛查是否存在OSA。
(王刚 四川大学华西医院中西医结合科呼吸组 610041 摘译)
（Chest; 2010; 138(3):543–550）
Association of obstructive sleep apnea risk with asthma control in adults
Teodorescu M, Polomis D.A.V. Hall SV. Teodorescu MC, Gangnon RE,. Peterson AG,Xie A, Sorkness CA,. Jarjour NN.
Chest; 2010; 138(3):543–550
Background: Unrecognized obstructive sleep apnea (OSA) may lead to poor asthma control despite optimal therapy. Our objective was to evaluate the relationship between OSA risk and asthma control in adults.
Methods: Patients with asthma seen routinely at tertiary-care clinic visits completed the validated Sleep Apnea Scale of the Sleep Disorders Questionnaire (SA-SDQ) and Asthma Control Questionnaire (ACQ). An ACQ score of ³1.5 defined not-well-controlled asthma, and an SA-SDQ score of ³36 for men and ³ 32 for women defined high OSA risk. Logistic regression was used to model associations of high OSA risk with not-well-controlled asthma (ACQ full version and short versions).
Results: Among 472 subjects with asthma, the mean 6 SD ACQ (full version) score was 0.87 ± 0.90, and 80 (17%) subjects were not well controlled. Mean SA-SDQ score was 27 ± 7, and 109 (23%) subjects met the definition of high OSA risk. High OSA risk was associated, on average, with 2.87-times higher odds for not-well-controlled asthma (ACQ full version) (95% CI, 1.54-5.32; P=0.0009) after adjusting for obesity and other factors known to worsen asthma control. Similar independent associations were seen when using the short ACQ versions.
Conclusions: High OSA risk is significantly associated with not-well-controlled asthma independent of known asthma aggravators and regardless of the ACQ version used. Patients who have difficulty achieving adequate asthma control should be screened for OSA.
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