How common is sleep-disordered breathing in patients with idiopathic pulmonary fibrosis?

Mermigkis, Charalampos; Stagaki, Eleni; Τryfon, Stavros; Schiza, Sophia; Amfilochiou, Anastasia; Polychronopoulos, Vlasis; Panagou, Panagiotis; Galanis, Nikolaos; Kallianos, Anastasios; Mermigkis, Dimitrios; Kopanakis, Antony; Varouchakis, Georgios; Kapsimalis, Fotis; Bouros, Demosthenes

doi:10.1007/s11325-010-0336-5

Cited by 124 publications

(110 citation statements)

References 14 publications

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“…Prior polysomnographic studies in the mid-1980s demonstrated alterations in sleep architecture and oxygen desaturation, especially during REM sleep, but not OSA, even in morbidly obese patients with ILDs [3,4]. The results of the study by Pihtili et al related to IPF patients are similar to recent studies that report increased incidence of OSA and pointed the need for high clinical suspicion for possible underlying OSA in this population [5][6][7][8]. Prior studies dating back 10-20 years probably underestimated hypopneas by using only thermal sensors and not nasal pressure transducers which are recognized as the sensitive devices for hypopnea detection that represents the majority of the observed respiratory events in IPF patients based on the newer studies.…”

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confidence: 65%

Obstructive sleep apnea in patients with interstitial lung diseases: past and future

2013

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In their article published in this issue of Sleep and Breathing, Pihtili et al. [1] present polysomnographic data in patients with interstitial lung diseases (ILDs) including 17 patients with idiopathic pulmonary fibrosis (IPF), 15 patients with stage II-III sarcoidosis, and 18 patients with pulmonary fibrosis due to scleroderma. The study revealed a high prevalence, namely 68 %, of obstructive sleep apnea (OSA) in this population. The prevalence of OSA was 82.3 % in the IPF patients, 66.6 % in the sarcoidosis patients, and 55.5 % in the scleroderma patients. The OSA severity was mostly mild, while the scored respiratory events were predominantly hypopneas. An interesting feature of this study is that this increased incidence of OSA was observed after the exclusion of patients with well-known predisposing factors for OSA such as obesity and/or significant upper airway pathologies causing obstruction. The authors used a disease severity index consisting of body mass index, carbon monoxide diffusion capacity, the Modified Medical Research Council dyspnea scale, and the 6-min walking distance, with scores ranging between 0 and 10. The OSA diagnosis rate was higher in the patients who had severity index ≥3.The frequency and consequences of OSA in patients with interstitial lung diseases is a field of growing research over the last years, although the medical literature on this area still remains quite limited with significant contraries between the results of older and more recent studies [2]. Prior polysomnographic studies in the mid-1980s demonstrated alterations in sleep architecture and oxygen desaturation, especially during REM sleep, but not OSA, even in morbidly obese patients with ILDs [3,4]. The results of the study by Pihtili et al. related to IPF patients are similar to recent studies that report increased incidence of OSA and pointed the need for high clinical suspicion for possible underlying OSA in this population [5][6][7][8]. Prior studies dating back 10-20 years probably underestimated hypopneas by using only thermal sensors and not nasal pressure transducers which are recognized as the sensitive devices for hypopnea detection that represents the majority of the observed respiratory events in IPF patients based on the newer studies. Related to sarcoidosis, Pihtili et al. report significantly higher percentages of OSA compared to previous studies [9] while the only one published study in scleroderma [10] found no OSA contrary to the high percentages observed by Pihtili et al.The available data of the above-mentioned studies show that OSA is common in patients with ILDs, especially those with IPF. Restrictive pulmonary diseases are characterized by decreased lung volumes that can reduce the upper airway stability and increase resistance due to a decreased traction on the upper airway. These changes can facilitate the upper airway collapse, especially during REM sleep when functional residual capacity is further reduced due to the inactivity of the intercostal muscles.The morbidity and mortality of OSA...

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Obstructive sleep apnea in patients with interstitial lung diseases: past and future

2013

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“…In this issue of SLBR, Mermigkis et al [6] analyzed the frequency of OSA in 34 IPF patients. In a prospective study, they investigated Sleep Disordered Breathing isorders (SRBD) in a newly diagnosed IPF population group before the start of any treatment and tried to identify correlations with pulmonary function testing parameters.…”

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Commentary on How common is sleep-disordered breathing in patients with idiopathic pulmonary fibrosis? Mermigkis C. et al.

Rühle

2010

Sleep Breath

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There are few recent studies on the issue of quality of sleep in interstitial lung disease [idiopathic pulmonary fibrosis (IPF)]. Early studies [1,2] showed that the patients developed significant desaturation during sleep, especially during REM sleep. In a comparative study with a healthy control group using PSG monitoring, SaO2 was reduced below 90% during 30% of sleep time. Furthermore, increased arousal, decreased sleep efficiency, and reduced Delta-sleep was found. These sleep disturbances had an effect on the subjective state/functionality, as measured by FOSQ and Pittsburgh (PSQI) [3]. Only recently, polysomnographic studies on the incidence of obstructive sleep apnea (OSA) in pulmonary fibrosis have been published [4,5].Data by Lancaster et al. [5] show an increased incidence of OSA in IPF patients. Forty-four of 50 subjects (88%) had OSA as defined by an AHI of >5 events per hour. Twenty percent of subjects had mild OSA (AHI, five to15 events per hour), and 68% had moderate-to-severe OSA (AHI >15 events per hour). The mean BMI of the whole group with OSA was 33. OSA was noted only in a small percentage of 11% of patients with normal BMI.In this issue of SLBR, Mermigkis et al. [6] analyzed the frequency of OSA in 34 IPF patients. In a prospective study, they investigated Sleep Disordered Breathing isorders (SRBD) in a newly diagnosed IPF population group before the start of any treatment and tried to identify correlations with pulmonary function testing parameters. They found a high prevalence of SDB and a statistically significant correlation of REM AHI with TLC. The BMI was only moderately increased and at least in mild to moderate OSA (AHI 5-15) not different from the BMI of the IPF patients without OSA (AHI <5). Thus, other additional factors should be responsible for the higher incidence of SRBD in IPF. Studies suggest that the mechanism underlying this association is probably a decrease in upper airway stiffness with lower lung volume caused by reduced caudal traction from the trachea.The results demonstrate that sleep-disordered breathing in IPF is more frequent than previously suspected .These patients currently have very limited therapeutic options concerning the fibrosing alveolitis. We need to turn greater attention to the association between IPF and OSAS because applying CPAP sleep and quality of life can eventually be ameliorated. We should not defer sleep testing.

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“…La correzione dei disturbi ostruttivi del sonno potrebbe avere un effetto benefico sulla sopravvivenza e sulla qualità di vita, dato che vari studi hanno dimostrato frammentazione del sonno, riduzione delle fasi REM, episodi di desaturazione e numerosi risvegli, nonché un alto indice di apnea/ipopnea. Inoltre, la bassa qualità di vita dei pazienti con IPF correla anche con gli score di qualità del loro sonno [38][39][40]. La prevalenza del RGE nella IPF varia tra 66-87% [41,42] e più di un terzo dei pazienti con reflusso documentato è asintomatico.…”

Section: Comorbiditàunclassified

[Nintedanib for the treatment of idiopathic pulmonary fibrosis in Italy]

Belisari¹,

Bettoni

Cortesi

et al. 2017

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To date, there are few therapeutic answers for Idiopathic pulmonary fibrosis (IPF) and only two pharmacological treatments have a marketing authorization for this disease. Recently nintedanib (Ofev®) has been authorized as a new therapeutic option and its economic profile has been evaluated by international Health Technology Assessment (HTA) bodies. IPF has important implications for everyday life of patients and their carers, negatively influencing their quality of life and bringing heavy economic burden to the NHS and to the entire society. It is, therefore important to consider these aspects for the Italian environment and to perform a pharmacoeconomic evaluation to define the efficiency of nintedanib in IPF by means of a Cost-Utility Analysis (CUA). As IPF is a chronic and progressive disease, a lifetime Markov model has been therefore developed with health states describing the patient’s condition as a combination of lung function and exacerbation history. The cohort entered in the model at different Forced Vital Capacity (FVC%) predicted health states, without exacerbation. The Clinical data used to perform this CUA were derived from clinical trials and the relative efficacy of nintedanib versus the comparator (pirfenidone) was then obtained from a Network Meta-Analysis (NMA) combining data reported in each primary study (INPULSIS 1-2 and TOMORROW trials for nintedanib, and CAPACITY and ASCEND trials for pirfenidone, respectively). At base-case, treatment with nintedanib resulted in a slightly lower estimated total cost vs pirfenidone, better safety profile and lower risk of acute exacerbations with an advantage in Quality Adjusted Life years (QALYs) gained. These results were confirmed by the sensitivity analysis. Although nintedanib appears to be a valuable option for the NHS to treat IPF patients, future data evidence, as long-term or real-life data, will help to confirm these results.[In Italian]

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How common is sleep-disordered breathing in patients with idiopathic pulmonary fibrosis?

Abstract: Sleep-disordered breathing seems frequent, although remains usually under diagnosed in IPF patients. A decrease in TLC, reflecting the severity of pulmonary restriction, might predispose IPF patients in SDB, especially during the vulnerable REM sleep period.

Cited by 124 publications

References 14 publications

Obstructive sleep apnea in patients with interstitial lung diseases: past and future

Obstructive sleep apnea in patients with interstitial lung diseases: past and future

Commentary on How common is sleep-disordered breathing in patients with idiopathic pulmonary fibrosis? Mermigkis C. et al.

[Nintedanib for the treatment of idiopathic pulmonary fibrosis in Italy]

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