Chronic Obstructive Pulmonary Disease With Sleep Apnea Hypopnea Syndrome (overlap Syndrome)

1.Study Background and Objective:Overlap syndrome(OS) is chronic obstructive pulmonary disease(COPD) combine with sleep apnea-hypopnea syndrome(SAHS),first proposed by Flenley in 1985.Both COPD and SAHS are common diseases,recently,the studies found that patients were high risk to get both diseases simultaneously,and the illness can affect each other and made more serious.OS patients who had under airway obstruction and upper airway obstruction would be more serious than COPD and SAHS.The intermittent hypoxia made various organs oxygen supply system disorder,a variety of complications.Therefore OS was the disease can not be ignored.The TCM etiology and pathogenesis of OS were rarely reported in the literature. Most of the clinical studies summarized of clinical experience of syndrome classification and treatment principles which were lack of scientific data.Therefore,we use Prospective Study,take the Polysomnography(PSG) test and pulmonary function tests,and observe the OS Syndrome related symptoms contained the tongue and vein, to find the rule of OS Syndrome.The study provides relatively reliable basis for clinical treatment,and lays a foundation for improved Chinese medicine efficacy.The objective is to investigate the OS Syndrome distribution rules,and promote standardization of its treatment of Syndrome;to observe the infection between SAHS and COPD when they combine with each other;to find the TCM etiology and pathogenesis of OS which will be guiding clinical treatment.We try to use Strengthening Spleen,Removing Phlegm and Tonifying Kidney to treat with the patients of spleen and kidney deficiency,turbid phlegm obstructing lung syndrome, t:han we observe the effects.Because of the high morbidity and various systems complications of COPD and SAHS,it's hard to take a prospective study on the human body with the pathogenesis research.There are many disturbing factors in clinical research,which make the research on the human body limited,so the relevant animal studies should be conducted.The expectations for this study through the establishment of the ideal chronic bronchitis combine with chronic intermittent hypoxia rat model,for further exploring the pathogenesis and the influence of OS to the various systems.2.Study Methods and ResultsStudy MethodsWe use the prospective study,pick the patients confirmed COPD or SAHS of to take PSG test or pulmonary function test.Every PSG test takes more than seven hours of monitoring,through the EEG,eye movement,ECG,nose and mouth airflow,chest and abdominal movement,blood Oxygen saturation,and so the final analysis. Pulmonary function test includes expiratory volume in one second(FEV1),forced vital capacity(FVC) and expiratory volume in one second / forced vital capacity(FEV1 / FVC).All the cases will take a OS TCM syndrome research survey,including Epworth sleepiness scale,demographic information questionnaire,past history,ill-individual -hygeian habits history,physical examination,Western medicine and Chinese medicine clinical symptoms.We analyze the OS TCM syndrome characteristics and types combined with physical fitness and the syndrome points.We use Erchen Tang and Erxian Tang decoction adjuvant treat 13 patients for 2 weeks,who were the most syndrome--spleen and kidney deficiency,turbid phlegm obstructing lung syndrome in OS TCM syndrome.They were using conventional methods of Western medicine,observe the change of day time blood gas analysis,FVC, FEV1 and FEV1 / FVC,the improve of cough,expectoration,difficulty in breathing, daytime sleepiness,fatigue and the general situation of the patients(including body temperature,spiritual,physical,appetite,etc.).50 clean health Wistar rats,male and female of half,were non-sharing randomly divided into three groups-the control group 12 rats,COPD model group 15 rats and OS model group 23 rats.Control group:normal feeding and will not do any interference.COPD model group:after three days normal feeding,would taken a modified smoking method to make a copy of COPD model.OS model group:like the COPD group rats made a copy of COPD model,then from the third day to 22 days, four times a day intermittent hypoxia,made COPD and chronic hypoxia model. Observing the change of general state of rats,blood gas analysis and blood rheology indexes.ResultsThe BMI and AHI in OS patients were higher than COPD and SAHS patients,it was significant;the FEV1,FVC descended in OS patients more than COPD and SAHS patients,it was significant;AHI and FEV1 was inverse relationship in OS patients,the higher AHI,the lower FEV1;PCO2 in OS group was higher than COPD group,it was significant.OS group's major syndrome elements were phlegm,damp,Qi deficiency,Yang deficiency,from lung,from kidney and from spleen.Main syndrome of OS group were turbid phlegm obstructing lung,deficiency of spleen and kidney,blood stasis, phlegm-heat obstructing lung,Qi deficiency of lung and spleen and Qi and Yin deficiency.The blood gas analysis and pulmonary function of 13 OS patients who were the syndrome of deficiency of spleen and kidney,turbid phlegm obstructing lung,got better after the treatment.The difference was significant.The total efficiency was 84.62%.The control group rats were normal.Two model group rats had a short breath, sometimes cough,mild cyanosis,delayed action,unresponsive,weight loss.Compared OS model group with the control group,PCO2 increased,PH and PO2 were no difference.Compared with COPD model,the three indicators were no significantly different.OS model group's low-cut whole blood viscosity reduction and hematocrit were higher than the control group.Other blood rheology indexes were no significantly different compared with the control group and COPD model group.3.Conclusion:Sleep apnea and lung function in OS patients were more serious than COPD and SAHS.The main OS Syndrome were turbid phlegm obstructing lung,deficiency of spleen and kidney,blood stasis,phlegm-heat obstructing lung,Qi deficiency of lung and spleen and Qi and Yin deficiency.The disease was in the lungs,involving the spleen and kidney. The effect of the treatment of Strengthening Spleen,Removing Phlegm and Tonifying Kidney was good.It improved blood-gas analyses,pulmonary function and the body's state of hypoxia.We had copied the classic model of COPD.The OS model has yet to be further improved.