Comparative Study On The Efficacy Of BiPAP In The Elderly COPD Patients With OSAHS Overlap Syndrome And Simple Elderly COPD Patients

Objective: By using of the Bi-level positive airway pressure(Bi PAP) to treat the overlap syndrome(OS) and chronic obstructive pulmonary disease(COPD) patients. Comparing the results of Polysomnography(PSG), the serum level of inflammation mediator C- reactive protein(CRP), heart rate variability(HRV) and 6-minutes walking test(6MWT) between the two groups patients before and after Bi PAP. Discussion the clinical effects of Bi PAP in OS patients. Methods: The elderly stable OS patients 35 cases and simple COPD patients 35 cases, a total of 70 cases were recruited in the geriatrics and respiratory department of Yanan University Affiliated Hospital from July, 2014 to December, 2015, male were forty-three cases, female were twenty-seven cases, the age ranged from sixty to eighty years old, the Body Mass Index(BMI) were from 20.3-32 Kg/m2, the history of smoking were thirty to fifty-two years. All of patients were underwent the full night PSG, and according to the monitoring results, those patients were divided into the OS and simple COPD group. The two groups patients were given the basic treatment and the Bi PAP therapy. All patients were in use at night, and keeping the using time not less than 5 hours a night, continuous use 7 night. The PSG, CRP, HRV and 6MWT were recorded before and after Bi PAP treatment on entry into the study, and these results were statistically analysis. Results: In OS group patients, the dates of Epworth Sleeping Scale were higher than the simple COPD group patients(P<0.05), the dates of 6-minutes walking distance(6MWD) were lower than the simple COPD group patients(P<0.05). After Bi PAP treatment:1. The apnoea hypopnoea index(AHI), oxygen desaturation index(ODI), lowest oxygen saturation(LSa O2) and nocturnal total apnea time(TAT) of the OS groups patients were significantly improving(P<0.05), ODI and LSa O2 of the COPD groups patients were significantly improved(P<0.05), however these changes were significantly greater in OS group patients than that of the simple COPD group patients.2. The CRP and HRV of OS group patients were significantly better(P<0.05), however the effects were not in the simple COPD group patients(P>0.05).3. The Bi PAP treatment significantly increased the 6MWD in both OS and simple COPD groups patients(P<0.05), and also decreased the pre-walking Borg Scale and pre-walking heart rate in the OS group patients(P<0.05), which was not obvious in the simple COPD group patients(P>0.05).4. In the linear correlation, the improvement of the AHI(?-AHI) and ODI(?-ODI) after Bi PAP treatment were significantly correlated with the improvement of 6MWD(?-6MWD)(r=0.503, p=0.002 and r=0.486, p=0.003) in the OS group patients. The factors of ?-AHI, ?-ODI, ?-LSa O2 and ?-6MWD were taken the multiple linear regression analysis stepwise, which revealed ?-AHI and ?-ODI were the main factors associated with the ?-6MWD. Conclusion:1.Compared with the simple COPD group patients, the OS group patients have more obvious daytime sleepiness and more serious walking capacity.2.The OS group patients have more obvious nocturnal hypoxia than the simple COPD group patients, the Bi PAP treatment can improve the nocturnal hypoxia in both OS and simple COPD groups patients.3.the Bi PAP treatment can effectively improve inflammatory, increase the HRV and enhance the walking capacity in OS group patients.