Estudio comparativo de pacientes con enfermedad pulmonar obstructiva crónica con y sin síndrome de apneas obstructivas durante el sueño

Calderón-Osuna, E.; Carmona Bernal, C.; Arenas Gordillo, M.; Fuentes Pradera, M.A.; Sánchez Armengol, A.; Capote Gil, F.

doi:10.1016/S0300-2896(15)30006-5

Archivos de Bronconeumología

ISSN: 0300-2896

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Vol. 35. Issue 11.

Pages 539-543 (December 1999)

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Pages 539-543 (December 1999)

DOI: 10.1016/S0300-2896(15)30006-5

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Estudio comparativo de pacientes con enfermedad pulmonar obstructiva crónica con y sin síndrome de apneas obstructivas durante el sueño

Comparison of patients with chronic obstructive pulmonary disease with and without obstructive sieep apnea

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E. Calderón-Osuna*, C. Carmona Bernal, M. Arenas Gordillo, M.A. Fuentes Pradera, A. Sánchez Armengol, F. Capote Gil

Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Servicio de Neumología. Hospital Universitario Virgen del Rocío. Sevilla

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Nos hemos planteado estudiar si la existencia de un síndrome de apneas obstructivas durante el sueño (SAOS) en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) implica diferencias en lo referente a la sintomatología clínica, el intercambio gaseoso durante la vigilia y el sueño, y la mecánica respiratoria, respecto a aquellos enfermos con una EPOC aislada. Hemos estudiado a 48 enfermos con EPOC, en 26 de los cuales (54,1%) se descartó la existencia de un SAOS (grupo EPOC-no SAOS) mediante polisomnografía, y en 22 (45,8%) se diagnosticó un SAOS asociado (grupo EPOC-SAOS). Los pacientes del grupo EPOC-SAOS presentaron mayor somnolencia diurna y un menor grado de disnea. No hubo diferencias en el índice de masa corporal. En el grupo EPOC-SAOS la PaO2 diurna fue significativamente menor que en el grupo EPOC-no SAOS (66,4±10,4 frente a 75,5±11,2mmHg; p=0,01), y no existieron diferencias en cuanto a la PaCO2. En el grupo EPOC-SAOS la presión inspiratoria máxima (Pimáx) fue de 70,6±23,8 cmH20, significativamente menor que la del grupo EPOC-no SAOS (Pimáx de 90,5±26,1 cmH2O; p=0,04). Los pacientes del grupo EPOC-no SAOS presentaron una mayor duración del sueño REM. Los parámetros de saturación nocturna se encontraron significativamente más alterados en el grupo con SAOS.

Concluimos que los pacientes con EPOC y SAOS presentaron alteraciones oximétricas no sólo durante el sueño sino también en vigilia más marcadas que aquellos que sólo tienen EPOC. En dichas alteraciones, podría desempeñar un papel importante la existencia de un deterioro de las presiones musculares respiratorias en este grupo de pacientes. Ambos grupos también presentan diferencias en la intensidad de algunos síntomas, como el grado de somnolencia diurna y la disnea.

Palabras clave:

SAOS

EPOC

Sueño

We aimed to study whether the presence of obstructive sieep apnea syndrome (OSAS) in patints with chronic obstructive pulmonary disease (COPD) led to differences in clinical picture, gas exchange during awake and sieep states and mechanical ventilation, in comparison with patients with COPD alone. We enrolled 48 COPD patients. In 26 (54.1%), OSAS was ruled out (non-OSAS COPD group) by polysomnography, and in 22 (45.8%) associated OSAS was diagnosed (OSAS COPD group). Patients in the OSAS COPD group experienced greater daytime sieepiness and less dyspnea. Body mass Índex was not significantly difference. The OSAS COPD group had significantly lower daytime PaO2 (66.4±10.4mmHg in the OSAS COPD group and 75.5±11.2 mmHg in the non-OSAS COPD group; p=0.01); there were no differenes in PaCO2. Pimax in the OSASCOPD group was 70.6±23.8 cmH2O, a level that was significantly lower than in the non-OSAS COPD group (Pimax, 90.5±26.1 cmH20; p=0.04).

Patients in the non-OSAS COPD group experienced longer periods of REM sieep. Nighttime saturation parameters were significantly different in the group with OSAS.

We conclude that patients with both OSAS and COPD experience greather oximetric changes than those without OSAS, during both sieep and awake states. The deterioration of respiratory muscle pressures in such patients may play an important role in the changes. The groups aiso present differences in the intensity of some symptoms, such as degree of daytyme sieepiness and dyspnea.

Key words:

COPD

Sieep

SAS

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