, Volume 185, Issue 3, pp 173–178 | Cite as

Sleep-Related Breathing Disorders in Patients with Idiopathic Pulmonary Fibrosis

  • Charalampos MermigkisEmail author
  • Jeffrey Chapman
  • Joseph Golish
  • Demetrios Mermigkis
  • Kumaraswamy Budur
  • Antony Kopanakis
  • Vlassis Polychronopoulos
  • Richard Burgess
  • Nancy Foldvary-Schaefer
Original Paper


Idiopathic pulmonary fibrosis (IPF) is a chronic and usually fatal lung disease of unknown etiology. The aim of this study was to describe clinical and polysomnographic features of sleep-related breathing disorders (SRBD) and to identify predictors of obstructive sleep apnea (OSA) in IPF patients. Eight hundred fifty-seven patients with IPF were admitted to the Cleveland Clinic from 2001 to 2005. An all-night polysomnogram (PSG) was performed in 18 of them to investigate complaints suggestive of sleep-disordered breathing. OSA was confirmed in 11 of the 18 IPF patients with complaints suggestive of sleep apnea, while the remain 7 patients had a diagnosis of primary snoring or upper airway resistance syndrome (UARS). All patients showed a reduction in sleep efficiency, REM sleep, and slow wave sleep. The apnea-hypopnea index (AHI) was positively correlated with body mass index (p < 0.0001, r = 0.80). The REM AHI and overall AHI were negatively correlated with FEV1 (p = 0.008, r = −0.59 and p = 0.04, r = −0.49, respectively) and FVC percentages (p = 0.03, r = −0.50 and p = 0.08, r = −0.42, respectively). Our study is the first describing SRBD in IPF patients. An increased BMI and a significant impairment in pulmonary function testing may be predictors of OSA in this population. In the absence of effective treatments for IPF, the diagnosis and treatment of comorbid SRBD may lead to improvements in quality of life.


Idiopathic pulmonary fibrosis (IPF) Obstructive sleep apnea (OSA) Upper airway resistance syndrome (UARS) Polysomnogram (PSG) 


  1. 1.
    American Thoracic Society/European Respiratory Society (2002) International multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 165:277–304Google Scholar
  2. 2.
    American Thoracic Society/European Respiratory Society (2000) Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement. Am J Respir Crit Care Med 161:646–664Google Scholar
  3. 3.
    Coultas DB, Zumwalt RE, Black WC, Sobonya RE (1994) The epidemiology of interstitial lung disease. Am J Respir Crit Care Med 150:967–972PubMedGoogle Scholar
  4. 4.
    Perez-Padilla R, West P, Lertzman M, Kryger M (1985) Breathing during sleep in patients with interstitial lung disease. Am Rev Respir Dis 132:224–229PubMedGoogle Scholar
  5. 5.
    Bye P, Issa F, Berthon-Jones M, Sullivan C (1984) Studies of oxygenation during sleep in patients with interstitial lung disease. Am Rev Respir Dis 129:27–32PubMedGoogle Scholar
  6. 6.
    Clark M, Cooper B, Singh S, et al. (2001) A survey of nocturnal hypoxaemia and health related quality of life in patients with cryptogenic fibrosing alveolitis. Thorax 56:482–486PubMedCrossRefGoogle Scholar
  7. 7.
    American Sleep Disorders Association (1997) Practice parameters for the indication for polysomnography and related procedures: Polysomnography Taske Force, American Sleep Disorders Association Standards of Practice Committee. Sleep 20:406–422Google Scholar
  8. 8.
    Bartolo A, Clymer B, Golish J, Burgess R (2000) The Polysomnogram Assay: A method to represent the overnight polysomnogram in a condensed format. Comput Biomed Res 33:110–125PubMedCrossRefGoogle Scholar
  9. 9.
    Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles, CA: Brain Information Service/Brain Research Institute, University of California at Los AngelesGoogle Scholar
  10. 10.
    American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research; the report of the American Academy of Sleep Medicine task force. Sleep 22:667–689Google Scholar
  11. 11.
    American Sleep Disorders Association (1992) EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:174–184Google Scholar
  12. 12.
    American Thoracic Society (1995) Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 152:1107–1136Google Scholar
  13. 13.
    Walters AS (1995) The International Restless Legs Syndrome Study Group. Toward a better definition of the restless legs syndrome. Mov Disord 10:634–642PubMedCrossRefGoogle Scholar
  14. 14.
    American Sleep Disorders Association (1993) Recording and scoring leg movements. The Atlas Task Force. Sleep 16(8):748–759Google Scholar
  15. 15.
    Prado G, Allen R, Trevisani V, Toscano V, Earley C (2002) Sleep disruption in systemic sclerosis (scleroderma) patients: clinical and polysomnographic findings. Sleep Med 2:341–345CrossRefGoogle Scholar
  16. 16.
    Turner GA, Lower EE, Corser BE, Gunther KL, Baughman RP (1997) Sleep apnea in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 14:61–64PubMedGoogle Scholar
  17. 17.
    McNicholas W, Coffey M, Fitzgerald M (1986) Ventilation and gas exchange during sleep in patients with interstitial lung disease. Thorax 41:777–782PubMedCrossRefGoogle Scholar
  18. 18.
    Resta O, Foschino-Barbaro MP, Legari G, et al. (2001) Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects. Int J Obes Relat Metab Disord 25:669–675PubMedCrossRefGoogle Scholar
  19. 19.
    Kripke DF, Ancoli-Israel S, Klauber MR, et al. (1997) Prevalence of sleep-disordered breathing in ages 40–64 years: A population-based survey. Sleep 20:65–76PubMedGoogle Scholar
  20. 20.
    Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep disordered breathing. JAMA 284:3015–3021PubMedCrossRefGoogle Scholar
  21. 21.
    Dixon JB, Schachter LM, O’Brien PE (2001) Sleep disturbance and obesity: changes following surgically induced weight loss. Arch Intern Med 161:102–106PubMedCrossRefGoogle Scholar
  22. 22.
    Ballard RD, Irvin CG, Martin RJ, et al. (1990) Influence of sleep on lung volume in asthmatic patients and normal subjects. J Appl Physiol 68:2034–2041PubMedGoogle Scholar
  23. 23.
    Hudgel DW, Devadatta P (1984) Decrease in functional residual capacity during sleep in normal humans. J Appl Physiol 57:1319–1322PubMedGoogle Scholar
  24. 24.
    Aronson RM, Carley DW, Onal E, Wilborn J, Lopata M (1991) Upper airway muscle activity and the thoracic volume dependence of upper airway resistance. J Appl Physiol 70:430–438PubMedGoogle Scholar
  25. 25.
    Gottlieb DJ, Yao Q, Redline S, Ali T, Mahowald MW (2000) Does snoring predict sleepiness independently of apnea and hypopnea frequency? Am J Respir Crit Care Med 162:1512–1517PubMedGoogle Scholar
  26. 26.
    Lindberg E, Carter N, Gislason T, Janson T (2001) Role of snoring and daytime sleepiness in occupational accidents. Am J Respir Crit Care Med 164:2031–2035PubMedGoogle Scholar
  27. 27.
    Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P (2005) A cause of excessive daytime sleepiness: the upper airway resistance syndrome. Chest 127:1–4CrossRefGoogle Scholar
  28. 28.
    Guilleminault C, Chowdhuri S (2000) Upper airway resistance syndrome is a distinct syndrome. Am J Respir Crit Care Med 161:1413–1415Google Scholar
  29. 29.
    Gold AR, Marcus CL, Dipalo F, Gold MS (2002) Upper airway collapsibility during sleep in upper airway resistance syndrome. Chest 121:1531–1540PubMedCrossRefGoogle Scholar
  30. 30.
    American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd ed. Westchesler, IL: American Academy of Sleep MedicineGoogle Scholar
  31. 31.
    Rees K, Kingshott R, Wraith P, Douglas N (2000) Frequency and significance of increased upper airway resistance during sleep. Am J Respir Crit Care Med 162:1210–1214PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Charalampos Mermigkis
    • 1
    • 4
    Email author
  • Jeffrey Chapman
    • 2
  • Joseph Golish
    • 1
  • Demetrios Mermigkis
    • 3
  • Kumaraswamy Budur
    • 1
  • Antony Kopanakis
    • 3
  • Vlassis Polychronopoulos
    • 3
  • Richard Burgess
    • 1
  • Nancy Foldvary-Schaefer
    • 1
  1. 1.Cleveland Clinic Sleep Disorders CenterClevelandUSA
  2. 2.Department of Pulmonary and Critical Care MedicineCleveland ClinicClevelandUSA
  3. 3.Third Pulmonary DepartmentSismanoglio General District HospitalAthensGreece
  4. 4.Cleveland Clinic Sleep Disorders CenterClevelandUSA

Personalised recommendations