OSA and Prolonged Oxygen Desaturation During Sleep Are Strong Predictors of Poor Outcome in IPF

Overview

Journal Lung

Specialty Pulmonary Medicine

Date 2017 Jul 5

PMID 28674777

Citations 27

Authors

Marcello Bosi

Giulia Milioli

Francesco Fanfulla

Sara Tomassetti

Jay H Ryu

Liborio Parrino

Silvia Riccardi

Andrea Melpignano

Anna Elisabetta Vaudano

Claudia Ravaglia

Paola Tantalocco

Andrea Rossi

Venerino Poletti

Affiliations

Soon will be listed here.

Abstract

Purpose: Sleep Breathing Disorders (SBD) are frequently found in idiopathic pulmonary fibrosis (IPF) and they are associated with worse quality of sleep and life and with higher mortality. The study aimed at evaluating the impact of SBD on prognosis (mortality or disease progression) in 35 patients with mild to moderate IPF.

Methods And Results: Obstructive sleep apnea (OSA) was diagnosed in 25/35 patients with IPF: 14/35 mild, 7/35 moderate, and 4/35 severe. According to the American Academy of Sleep Medicine (AASM) definition, sleep-related hypoxemia was found in 9/35 patients with IPF. According to the presence/absence of SBD, IPF patients were divided into 4 groups: NO-SBD group (Group A, 25.7%), OSA without sleep-related hypoxemia (Group B, 48.5%), OSA with sleep-related hypoxemia group (Group C, 22.8%), and only 1/35 had sleep-related hypoxemia without OSA(Group D, 2.8%). Statistical analysis was focused only on group A, B, and C. Patients with OSAS and sleep-related hypoxemia (Group C) had the worse prognosis, both in terms of mortality or clinical deterioration. SBD were the only independent risk factor (Cox Proportional Hazards Multiple Regression Analysis) for mortality (HR 7.6% IC 1.2-36.3; p = 0.029) and disease progression (HR 9.95% IC 1.8-644.9; p = 0.007).

Conclusions: SBD are associated with a worse prognosis, both in terms of mortality or clinical progression. The presence of SBD should be explored in all IPF patients.

Citing Articles

The histone demethylase KDM6B links obstructive sleep apnea to idiopathic pulmonary fibrosis.

Han S, Huang J, Yang C, Feng J, Wang Y FASEB J. 2025; 39(1):e70306.

PMID: 39781582 PMC: 11712539. DOI: 10.1096/fj.202402813R.

Understanding the link between interstitial lung disease and obstructive sleep apnea: is lung volume involved?.

Genta P, Mariano P J Bras Pneumol. 2024; 50(5):e20240356.

PMID: 39661849 PMC: 11601080. DOI: 10.36416/1806-3756/e20240356.

Obstructive sleep apnea in patients with fibrotic interstitial lung disease (non-idiopathic pulmonary fibrosis): what should be offered?.

Cardoso C, Valente C, Serino M, Rodrigues I, Carvalho A, Coelho D J Bras Pneumol. 2024; 50(5):e20240058.

PMID: 39661832 PMC: 11601067. DOI: 10.36416/1806-3756/e20240058.

KL‑6, ET‑1 and S100A9 levels in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea.

Bouloukaki I, Michelakis S, Tsitoura E, Vasarmidi E, Koutoulaki C, Tzanakis N Exp Ther Med. 2024; 29(1):16.

PMID: 39624594 PMC: 11609610. DOI: 10.3892/etm.2024.12766.

Treating sleep-disordered breathing of idiopathic pulmonary fibrosis patients with CPAP and nocturnal oxygen treatment. A pilot study : Sleep-disordered breathing treatment in IPF.

Bordas-Martinez J, Salord N, Vicens-Zygmunt V, Carmezim J, Perez S, Prado E Respir Res. 2024; 25(1):247.

PMID: 38890648 PMC: 11186220. DOI: 10.1186/s12931-024-02871-6.

References

Mermigkis C, Bouloukaki I, Schiza S . Obstructive sleep apnea in patients with interstitial lung diseases: past and future. Sleep Breath. 2013; 17(4):1127-8. DOI: 10.1007/s11325-013-0836-1. View

Ley B, Ryerson C, Vittinghoff E, Ryu J, Tomassetti S, Lee J . A multidimensional index and staging system for idiopathic pulmonary fibrosis. Ann Intern Med. 2012; 156(10):684-91. DOI: 10.7326/0003-4819-156-10-201205150-00004. View

Pitsiou G, Bagalas V, Boutou A, Stanopoulos I, Argyropoulou-Pataka P . Should we routinely screen patients with idiopathic pulmonary fibrosis for nocturnal hypoxemia?. Sleep Breath. 2012; 17(2):447-8. DOI: 10.1007/s11325-012-0716-0. View

Mermigkis C, Stagaki E, Tryfon S, Schiza S, Amfilochiou A, Polychronopoulos V . How common is sleep-disordered breathing in patients with idiopathic pulmonary fibrosis?. Sleep Breath. 2010; 14(4):387-90. DOI: 10.1007/s11325-010-0336-5. View

Milioli G, Bosi M, Poletti V, Tomassetti S, Grassi A, Riccardi S . Sleep and respiratory sleep disorders in idiopathic pulmonary fibrosis. Sleep Med Rev. 2015; 26:57-63. DOI: 10.1016/j.smrv.2015.03.005. View

Becker H, Piper A, FLYNN W, McNamara S, Grunstein R, PETER J . Breathing during sleep in patients with nocturnal desaturation. Am J Respir Crit Care Med. 1999; 159(1):112-8. DOI: 10.1164/ajrccm.159.1.9803037. View

Schiza S, Mermigkis C, Margaritopoulos G, Daniil Z, Harari S, Poletti V . Idiopathic pulmonary fibrosis and sleep disorders: no longer strangers in the night. Eur Respir Rev. 2015; 24(136):327-39. PMC: 9487812. DOI: 10.1183/16000617.00009114. View

Kreuter M, Wuyts W, Renzoni E, Koschel D, Maher T, Kolb M . Antacid therapy and disease outcomes in idiopathic pulmonary fibrosis: a pooled analysis. Lancet Respir Med. 2016; 4(5):381-9. DOI: 10.1016/S2213-2600(16)00067-9. View

Antoniou K, Tomassetti S, Tsitoura E, Vancheri C . Idiopathic pulmonary fibrosis and lung cancer: a clinical and pathogenesis update. Curr Opin Pulm Med. 2015; 21(6):626-33. DOI: 10.1097/MCP.0000000000000217. View

10.

Jo H, Randhawa S, Corte T, Moodley Y . Idiopathic Pulmonary Fibrosis and the Elderly: Diagnosis and Management Considerations. Drugs Aging. 2016; 33(5):321-34. DOI: 10.1007/s40266-016-0366-1. View

11.

Bye P, Issa F, Sullivan C . Studies of oxygenation during sleep in patients with interstitial lung disease. Am Rev Respir Dis. 1984; 129(1):27-32. DOI: 10.1164/arrd.1984.129.1.27. View

12.

Mermigkis C, Bouloukaki I, Antoniou K, Papadogiannis G, Giannarakis I, Varouchakis G . Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis. Sleep Breath. 2014; 19(1):385-91. DOI: 10.1007/s11325-014-1033-6. View

13.

Drent M, du Bois R, Poletti V . Recent advances in the diagnosis and management of nonspecific interstitial pneumonia. Curr Opin Pulm Med. 2003; 9(5):411-7. DOI: 10.1097/00063198-200309000-00013. View

14.

Poletti V, Ravaglia C, Buccioli M, Tantalocco P, Piciucchi S, Dubini A . Idiopathic pulmonary fibrosis: diagnosis and prognostic evaluation. Respiration. 2013; 86(1):5-12. DOI: 10.1159/000353580. View

15.

Papiris S, Kagouridis K, Kolilekas L, Papaioannou A, Roussou A, Triantafillidou C . Survival in Idiopathic pulmonary fibrosis acute exacerbations: the non-steroid approach. BMC Pulm Med. 2015; 15:162. PMC: 4678631. DOI: 10.1186/s12890-015-0146-4. View

16.

De Boer K, Lee J . Under-recognised co-morbidities in idiopathic pulmonary fibrosis: A review. Respirology. 2015; 21(6):995-1004. DOI: 10.1111/resp.12622. View

17.

Papiris S, Kagouridis K, Kolilekas L, Bouros D, Manali E . Idiopathic pulmonary fibrosis acute exacerbations: where are we now?. Expert Rev Respir Med. 2014; 8(3):271-3. DOI: 10.1586/17476348.2014.896206. View

18.

Raghu G, Collard H, Egan J, Martinez F, Behr J, Brown K . An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011; 183(6):788-824. PMC: 5450933. DOI: 10.1164/rccm.2009-040GL. View

19.

Kolilekas L, Manali E, Vlami K, Lyberopoulos P, Triantafillidou C, Kagouridis K . Sleep oxygen desaturation predicts survival in idiopathic pulmonary fibrosis. J Clin Sleep Med. 2013; 9(6):593-601. PMC: 3659380. DOI: 10.5664/jcsm.2758. View

20.

Fanfulla F, Grassi M, Taurino A, DArtavilla Lupo N, Trentin R . The relationship of daytime hypoxemia and nocturnal hypoxia in obstructive sleep apnea syndrome. Sleep. 2008; 31(2):249-55. PMC: 2225567. DOI: 10.1093/sleep/31.2.249. View