Sleep Quality and Associated Daytime Consequences in Patients with Idiopathic Pulmonary Fibrosis

Abstract

Objective: The aim of this study was to describe sleep quality and associated daytime consequences in idiopathic pulmonary fibrosis (IPF). Subjects and Methods: Fifteen patients with IPF and 15 control subjects matched on age and anthropometric variables were included in the study. Sleep quality and its daytime consequences were assessed by clinical interview, the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes in Sleep Questionnaire (FOSQ), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale and attended all-night polysomnography. Results: Polysomnography revealed a decrease in sleep efficiency and slow wave sleep, and an increase in stage 1 sleep and arousal index in IPF patients compared to controls. Daytime tachypnea persisted during sleep. Oxygen saturation below 90% was observed during 34.3 ± 37.3% of the total sleep time (TST). Quality of sleep and daytime function were moderately to significantly impaired based on the PSQI and FOSQ. The total FOSQ score was negatively correlated with TST with oxygen saturation below 90% (p = 0.01, r = –0.62). FSS scores were correlated with TST at oxygen saturation below 90% and mean oxygen saturation during sleep (p = 0.002, r = 0.74, and p = 0.007, r = –0.66, respectively). Conclusions: Our data suggest significant sleep disruption and consequent impairment of physical and social functioning in patients with IPF. In the absence of effective treatments for IPF, the improvement of sleep quality should be a primary therapeutic goal.

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

“…The authors hypothesised that the lack of change might be due to the maintenance of reflexes causing rapid, shallow breathing during sleep. The same breathing pattern was observed in a more recent study by MERMIGKIS et al [16] including 15 IPF patients with diagnosis based on the 2002 ATS/ERS criteria and 15 matched control subjects. In contrast, MCNICHOLAS et al [17], in an older study including seven patients (five with IPF, two with farmer's lung), demonstrated that respiratory frequency declined significantly between wakefulness and sleep in ILD patients.…”

“…Fatigue is one of the most frequently reported symptoms in ILD and has a marked impact on patients' wellbeing [71]. MERMIGKIS et al [16] reported a significant correlation between mean nocturnal SaO 2 and fatigue scores in patients with IPF and found that nocturnal hypoxia explained up to 45% of the variance on fatigue scores. Although, as reported in the previous section, a benefit in sleep-related quality of life was reported following institution of CPAP for patients with IPF and OSA, studies are needed to assess the hypothesis that the use of supplemental oxygen could beneficially affect fatigue and quality of life in patients with ILD.…”

Clinical Correlates of Reduced Physical Activity in Idiopathic Pulmonary Fibrosis

“…One aspect, partly reflected in quality of life measures, is fatigue [9,11] - a debilitating and complex symptom. Although fatigue is increasingly recognized in IPF patients [9,12], data on specific questionnaires investigating this multifactorial symptom in IPF are sparse [12,13], and associations between PA and fatigue have not been studied so far.…”

Supplemental Oxygen Needs During Sleep. Who Benefits?

“…50,51 Similarly, subjective sleep quality is poor in other respiratory diseases, such as COPD and pulmonary fibrosis, with some studies also confirming objectively worse sleep, based on total sleep time or sleep fragmentation. [52][53][54][55] Thus, lung disease can predispose to acute and chronic sleep deprivation.…”