阻塞性睡眠呼吸暂停和胃食管反流对肥胖患者哮喘控制的影响
2011/10/13
摘要
背景：肥胖是哮喘的一个危险因素。肥胖的哮喘患者常常存在哮喘控制差及疗效反应差等问题。有证据显示，肥胖相关的共患疾病如反流性食管炎和阻塞性睡眠呼吸暂停，是导致肥胖患者哮喘控制较差的主要原因。
目的：本试验旨在研究（1）反流和/或（2）睡眠呼吸暂停症状是否是导致肥胖患者哮喘控制较差的原因。
方法：对参与反流治疗试验的哮喘患者进行研究。参与者在基线状态下接受哮喘症状和肺功能评价。完成食道pH值检测的参与者共有304名，完成阻塞性睡眠呼吸暂停症状评价的参与者有246名。
结果：402名参与者中，51%的参与者存在肥胖。反流在哮喘控制中的作用：体重指数较大的患者反流症状更常见，但各组酸反流的pH值检测结果相似。反流与肥胖患者的哮喘控制指标无关。阻塞性睡眠呼吸暂停在哮喘控制中的作用：阻塞性睡眠呼吸暂停症状及其自我主诉在体重指数增加的参与者中更为常见，而且还与Juniper哮喘控制问卷调查和哮喘症状使用指数检测显示的哮喘控制较差相关。
结论：数据显示，导致肥胖患者哮喘控制较差的主要原因是阻塞性睡眠呼吸暂停，而非胃食管反流疾病。
背景：肥胖是哮喘的一个危险因素。肥胖的哮喘患者常常存在哮喘控制差及疗效反应差等问题。有证据显示，肥胖相关的共患疾病如反流性食管炎和阻塞性睡眠呼吸暂停，是导致肥胖患者哮喘控制较差的主要原因。
目的：本试验旨在研究（1）反流和/或（2）睡眠呼吸暂停症状是否是导致肥胖患者哮喘控制较差的原因。
方法：对参与反流治疗试验的哮喘患者进行研究。参与者在基线状态下接受哮喘症状和肺功能评价。完成食道pH值检测的参与者共有304名，完成阻塞性睡眠呼吸暂停症状评价的参与者有246名。
结果：402名参与者中，51%的参与者存在肥胖。反流在哮喘控制中的作用：体重指数较大的患者反流症状更常见，但各组酸反流的pH值检测结果相似。反流与肥胖患者的哮喘控制指标无关。阻塞性睡眠呼吸暂停在哮喘控制中的作用：阻塞性睡眠呼吸暂停症状及其自我主诉在体重指数增加的参与者中更为常见，而且还与Juniper哮喘控制问卷调查和哮喘症状使用指数检测显示的哮喘控制较差相关。
结论：数据显示，导致肥胖患者哮喘控制较差的主要原因是阻塞性睡眠呼吸暂停，而非胃食管反流疾病。
（苏楠 审校）
J Asthma. 2011 Sep;48(7):707-13. Epub 2011 Aug 8.
J Asthma. 2011 Sep;48(7):707-13. Epub 2011 Aug 8.
Effects of obstructive sleep apnea and gastroesophageal reflux disease on asthma control in obesity.
Dixon AE, Clerisme-Beaty EM, Sugar EA, Cohen RI, Lang JE, Brown ED, Richter JE, Irvin CG, Mastronarde JG.
Source
Department of Medicine, University of Vermont College of Medicine , Burlington, VT , USA .
Abstract
BACKGROUND： Obesity is a risk factor for asthma. Obese asthmatics often have poor asthma control and respond poorly to therapy. It has been suggested that co-morbidities associated with obesity, such as reflux and obstructive sleep apnea, could be important factors contributing to poor asthma control in obese patients. OBJECTIVES： The purpose of this study was to determine if (1) reflux and/or (2) symptoms of sleep apnea contribute to poor asthma control in obesity.
METHODS： We studied asthmatic subjects participating in a trial of reflux treatment. Participants underwent baseline evaluation of asthma symptoms and lung function. Overall 304 participants underwent esophageal pH probe testing; 246 participants were evaluated for obstructive sleep apnea symptoms.
RESULTS： Of 402 participants in this trial, 51% were obese. Role of reflux in asthma control. Those with higher body mass index (BMI) reported a higher prevalence of reflux symptoms, but the prevalence of pH probe acid reflux was similar in all groups. Reflux was not associated with measures of asthma control in obese patients. Role of obstructive sleep apnea in asthma control. Symptoms and self-report of obstructive sleep apnea were more common with increasing BMI and associated with worse asthma control as measured by the Juniper Asthma Control questionnaire and Asthma Symptom Utility Index.
CONCLUSIONS： Our data suggest that obstructive sleep apnea, but not gastroesophageal reflux disease, may contribute significantly to poor asthma control in obese patients.
J Asthma. 2011 Sep;48(7):707-13. Epub 2011 Aug 8.
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