一例重度COPD-OSA重叠综合征的四年管理：分阶段闭环呼吸康复——病例报告

文献信息

中文摘要

背景： 重度COPD-OSA重叠综合征的管理仍具挑战性，现有方法很少将指南导向的OSA治疗与持续的肺康复相结合，使患者易反复发生急性加重。病例介绍：一名71岁男性重度重叠综合征患者，曾因高碳酸血症性脑病需要侵入性通气而住院三次。2021年入院后，我们实施了为期四年、分三阶段的闭环康复方案，并结合由美国睡眠医学会（AASM）和2023年GOLD推荐意见指导的多模式OSA管理。该方案包括个体化BiPAP滴定、每季度压力调整、体位治疗和针对性体重控制。管理与结局：在四年随访中，这种联合方法改善了动脉血气值和运动耐量，并显著改善了睡眠呼吸障碍参数，未再因呼吸衰竭而再入院。结论：符合指南的多模式OSA治疗联合分阶段闭环呼吸康复可能为重度重叠综合征提供有效的长期策略。然而，由于单例病例报告的结果具有假设生成性，仍需在更大规模的前瞻性研究中验证。

英文摘要

Background: Severe COPD-OSA overlap syndrome remains challenging to manage, and existing approaches rarely combine guideline-directed OSA therapy with sustained pulmonary rehabilitation, leaving patients vulnerable to recurrent acute exacerbations. Case Presentation: A 71-year-old male with severe overlap syndrome had been hospitalized three times for hypercapnic encephalopathy requiring invasive ventilation. Following admission in 2021, we implemented a four-year, three-stage closed-loop rehabilitation program combined with multimodal OSA management guided by the American Academy of Sleep Medicine (AASM) and 2023 GOLD recommendations. The program included personalized BiPAP titration, quarterly pressure adjustments, positional therapy, and targeted weight control. Management and Outcomes: Over four years of follow-up, this combined approach improved arterial blood gas values and exercise tolerance and markedly improved sleep-disordered breathing parameters, with no readmissions for respiratory failure. Conclusions: Guideline-conformant multimodal OSA therapy combined with staged closed-loop respiratory rehabilitation may offer an effective long-term strategy for severe overlap syndrome. However, as the findings of a single case report are hypothesis-generating, they require validation in larger prospective studies.