Sleep Oxygen Desaturation Predicts Survival in Idiopathic Pulmonary Fibrosis

Abstract

background: Recent studies suggest poor sleep quality in patients with idiopathic pulmonary fi brosis (IPF). However, so far, the impact of IPF-related sleep breathing disorders (SBDs) on survival has not been extensively studied. Methods: In a cohort of 31 (24 males) treatment-naïve, newly diagnosed consecutive IPF patients, we prospectively investigated the relationship of SBD parameters such as apnea-hypopnea index (AHI), maximal difference in oxygen saturation between wakefulness and sleep (maxdiff SpO 2 ), and lowest sleep oxygen saturation (lowest SpO 2 ) with clinical (survival, dyspnea, daytime sleepiness), pulmonary function, submaximal (6-min walk test [6MWT]) and maximal exercise variables (cardiopulmonary exercise test [CPET]), and right ventricular systolic pressure (RVSP). Results: Sleep oxygen desaturation exceeded signifi cantly that of maximal exercise (p < 0.001). Maxdiff SpO 2 was inversely related to survival, DLCO%, and SpO 2 after 6MWT, and directly with dyspnea, AHI, and RVSP. The lowest SpO 2 was directly related to survival and to functional (TLC%, DLCO%) as well as submaximal and maximal exercise variables (6MWT

Comorbidities in idiopathic pulmonary fibrosis patients: a systematic literature review

“…The prevalence of OSA ranged from 5.9% in an analysis of 9286 patients with IPF identified from two US claims databases [26] to 91% among 31 patients from an outpatient interstitial lung disease unit in Greece who underwent a polysomnogram (figure 4) [79]. OSA appeared to be more common among patients with a higher body mass index (BMI) in the studies included in this review.…”

“…An analysis of 21 IPF patients found that BMI was higher in patients with an apnoea-hypopnoea index (AHI) ⩾5 (29.72 ±0.81) versus <5 (27.50±1.71; p=0.053) and BMI was positively correlated with AHI (r=0.59, p=0.001) [80]. One study examined the association between OSA and mortality [79]. A significant association was found between nocturnal hypoxaemia and mortality with a hypothesis that intermittent oxygen desaturation, which occurs during sleep as a result of OSA, contributes to PH and associated mortality.…”

“…The prevalence of abnormal GER was reported in 23 studies [4,10,26,27,48,75,79,80,[101][102][103][104][105][106][107][108][109][110][111][112][113][114][115] (online supplementary table S6) and ranged from 0 among 20 IPF patients in Ireland who were participating in a study exploring the degree and mechanisms of sleep-disordered breathing, and for whom no history of GER was noted [80], to 94.1% in an analysis of consecutive, newly diagnosed IPF patients recruited from a single US centre [112] (figure 6). However, the 94% prevalence was based on a 24-h ambulatory physiological definition of abnormal acid GER: a most sensitive method of ascertaining abnormal acid GER that included abnormal acid exposure in the distal and/or proximal oesophagus.…”

“…Obstructive sleep apnoea Seven papers reported data on the prevalence of OSA in patients with IPF, of which three were from Europe [77,79,80] and four were from the USA [7,26,28,81] (online supplementary table S3). The prevalence of OSA ranged from 5.9% in an analysis of 9286 patients with IPF identified from two US claims databases [26] to 91% among 31 patients from an outpatient interstitial lung disease unit in Greece who underwent a polysomnogram (figure 4) [79].…”

Idiopathic pulmonary fibrosis and sleep disorders: no longer strangers in the night

“…The authors recognised the need for further studies to assess not only the negative influence of untreated OSA on the quality of life of IPF patients, but also the possible contribution of OSA to IPF progression and mortality. Another study by KOLILEKAS et al [33] in a cohort of 31 treatment-naïve, newly diagnosed, consecutive IPF patients reported that intermittent sleep oxygen desaturation significantly exceeds that of maximal exercise and is associated with survival in IPF patients. Among the included subjects, 12 (38.7%) patients had mild and 16 (51.6%) patients had moderate-to-severe OSA.…”