Comparison of hospitalized patients with idiopathic pulmonary fibrosis and obstructive sleep apnea outpatients in terms of general characteristics and polysomnographic features

Yıl 2021, Cilt: 3 Sayı: 3, 198 - 203, 14.07.2021

Bengü Şaylan

https://doi.org/10.38053/acmj.890109

Öz

Objective: Obstructive sleep apnea (OSA) is a significant comorbidity in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to evaluate the demographic and clinical characteristics of patients with and without IPF, and their polysomnographic features according to the presence and severity of OSA.
Methods: A total of 52 cases (29 patients hospitalized for IPF and 23 controls without IPF) admitted to the sleep laboratory with suspicion of OSA were included. Demographic, clinical data and results of polysomnographic studies were recorded from the patients’ self-reports and hospital records.
Results: The distribution of sex was similar (p=0.775) between the patient and control groups; however, the patients with IPF were older than the controls (68 vs. 57 years, p=0.003). The rate of current smokers was higher among the controls (p=0.003), whereas dyspnea (p<0.001), headache (p=0.005), congestive heart failure (p=0.013), pulmonary hypertension (p<0.001), number of previous hospitalizations (p<0.001), and dust exposure (p=0.028) were more frequent in the IPF group. The median sleep time with O2 saturation below 90% was significantly higher in the IPF group (p<0.001). Among overall study population, 40 patients had OSA of whom 10 had mild, 15 had moderate, and 15 had severe OSA.
Conclusions: The co-existence of IPF significantly worsened the polysomnographic features of the patients with OSA. Further studies are needed to clarify the underlying mechanisms and to determine the optimal interventions to increase sleep quality of IPF patients.

Anahtar Kelimeler

Idiopathic pulmonary fibrosis, obstructive sleep apnea, severity, hospitalization, polysomnography

Kaynakça

• Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis 2015; 6: 273-85.
• Hiestand DM, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll. Chest 2006; 130: 780-6.
• Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2018; 198: e44-e68.
• Schiza SE, Bouloukaki I, Bolaki M, Antoniou KM. Obstructive sleep apnea in pulmonary fibrosis. Curr Opin Pulm Med 2020; 26: 443-8.
• Mermigkis C, Bouloukaki I, Antoniou K, et al. Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis. Sleep Breath 2015; 19: 385-91.
• Gille T, Didier M, Boubaya M, et al. Obstructive sleep apnoea and related comorbidities in incident idiopathic pulmonary fibrosis. Eur Respir J 2017; 49: 1601934.
• King C, Nathan SD. Identification and treatment of comorbidities in idiopathic pulmonary fibrosis and other fibrotic lung diseases. Curr Opin Pulm Med 2013; 19: 466-73.
• Mermigkis C, Bouloukaki I, Antoniou K, et al. Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis. Sleep Breath 2015; 19: 385-91.
• Gille T, Didier M, Boubaya M, et al., Natural history of idiopathic pulmonary fibrosis (IPF) associated with obstructive sleep apnea (OSA) with or without continuous positive airway pressure (CPAP), in Idiopathic interstitial pneumonias. Eur Respir J 2018 52: PA2911.
• Bosi M, Milioli G, Fanfulla F, et al. OSA and prolonged oxygen desaturation during sleep are strong predictors of poor outcome in IPF. Lung 2017; 195: 643-51.
• Mermigkis C, Bouloukaki I, Schiza SE. Sleep as a new target for improving outcomes in idiopathic pulmonary fibrosis. Chest 2017; 152: 1327-38.
• Tudorache V, Traila D, Marc M, et al. Impact of moderate to severe obstructive sleep apnea on the cognition in idiopathic pulmonary fibrosis. PLoS One 2019; 14: e0211455.
• Lederer DJ, Jelic S, Bhattacharya J, Basner RC. Is obstructive sleep apnea a cause of idiopathic pulmonary fibrosis? Arch Pathol Lab Med 2012; 136: 470.
• Toumpanakis D, Kastis GA, Zacharatos P, et al. Inspiratory resistive breathing induces acute lung injury. Am J Respir Crit Care Med 2010; 182: 1129-36.
• Ichimura H, Parthasarathi K, Quadri S, Issekutz AC, Bhattacharya J. Mechano-oxidative coupling by mitochondria induces proinflammatory responses in lung venular capillaries. J Clin Invest 2003; 111: 691-9.
• Glucksberg MR, Bhattacharya J. Effect of alveolar and pleural pressures on interstitial pressures in isolated dog lungs. J Appl Physiol (1985) 1991; 70: 914-8.
• Al-Alawi A, Mulgrew A, Tench E, Ryan CF. Prevalence, risk factors and impact on daytime sleepiness and hypertension of periodic leg movements with arousals in patients with obstructive sleep apnea. J Clin Sleep Med 2006; 2: 281-7.
• Bixler EO, Kales A, Vela-Bueno A, Jacoby JA, Scarone S, Soldatos CR. Nocturnal myoclonus and nocturnal myoclonic activity in the normal population. Res Commun Chem Pathol Pharmacol 1982; 36: 129-40.
• Hornyak M, Feige B, Riemann D, Voderholzer U. Periodic leg movements in sleep and periodic limb movement disorder: prevalence, clinical significance and treatment. Sleep Med Rev 2006; 10: 169-77.
• Yalın OÖ, Yılmaz İA, Sungur MA, Doğu O. Obstructive sleep apnea syndrome, periodic limb movements and related factors. Turk J Neurol 2015; 21: 90-4.
• Zhang XB, Zen HQ, Lin QC, Chen GP, Chen LD, Chen H. TST, as a polysomnographic variable, is superior to the apnea hypopnea index for evaluating intermittent hypoxia in severe obstructive sleep apnea. Eur Arch Otorhinolaryngol 2014; 271: 2745-50.