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Lung

, Volume 195, Issue 5, pp 643–651 | Cite as

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

  • Marcello BosiEmail author
  • 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
Article

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.

Keywords

Idiopathic pulmonary fibrosis Obstructive sleep apnea Sleep-related hypoxemia Mortality 

Abbreviations

6Mwtest

6 minutes walking test

6MWD

6 minutes walking distance

AE

Acute phase

AHI

Apnea hypopea index,

BMI

Body mass index

Dlco

Diffusion lung capacity for carbon monoxide (% or predicted)

FEV1

Forced expiratory volume in the first second

FVC

Forced vital capacity

IPF

Idiopathic pulmonary fibrosis

ODI

Oxygen desaturation index

OSA

Obstructive sleep apnea

PaCO2

Arterial carbon dioxide partial pressure

PaO2

Arterial oxygen partial pressure

POD

Death or the first episode of progression of disease

RDI

Respiratory disturbance index

RERA

Respiratory effort related arousal

SaO2

Average SpO2 during sleep

SaO2w

Average SpO2 during wakefulness

SBD

Sleep Breathing Disorders

SE

Sleep efficiency

T90

% of total sleep time spent with SpO2 < 90%

TST

Total sleep time

V/Q

Ventilation/perfusion relationship

WASO

Wake time after sleep onset

Notes

Author Contributions

MB, GM, FF, and LP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. MB, GM, FF, LP, ST, JHR, SR, AM, AEV, CR, PT, AR, VP contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.

Compliance with Ethical Standards

Conflict of interest

This was not an industry supported study. 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, and Venerino Poletti have indicated no financial conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Marcello Bosi
    • 1
    Email author
  • Giulia Milioli
    • 2
  • Francesco Fanfulla
    • 3
  • Sara Tomassetti
    • 1
  • Jay H. Ryu
    • 4
  • Liborio Parrino
    • 2
  • Silvia Riccardi
    • 2
  • Andrea Melpignano
    • 2
  • Anna Elisabetta Vaudano
    • 2
  • Claudia Ravaglia
    • 1
  • Paola Tantalocco
    • 1
  • Andrea Rossi
    • 4
  • Venerino Poletti
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
  1. 1.Department of Diseases of the ThoraxGB Morgagni Hospital, Asl RomagnaForlìItaly
  2. 2.Sleep Disorders Center, Dept of NeurosciencesUniversity of ParmaParmaItaly
  3. 3.Sleep Medicine Unit and Sleep Research Laboratory S. Maugeri Foundation IRCCS – Scientific Insitute of PaviaPaviaItaly
  4. 4.Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterUSA
  5. 5.Pulmonology Operative UnitVerona UniversityVeronaItaly
  6. 6.Department of Respiratory Diseases & AllergyAarhus University HospitalAarhusDenmark

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