Sleep and Breathing

, Volume 19, Issue 1, pp 385–391 | Cite as

Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis

  • Charalampos MermigkisEmail author
  • Izolde Bouloukaki
  • Katerina Antoniou
  • Georgios Papadogiannis
  • Ioannis Giannarakis
  • Georgios Varouchakis
  • Nikolaos Siafakas
  • Sophia E. Schiza
Original Article


Study objectives

The most recent idiopathic pulmonary fibrosis (IPF) guidelines include obstructive sleep apnea (OSA) among the IPF-associated comorbidities. Furthermore, they recognize the paucity of studies related to continuous positive airway pressure(CPAP) treatment in this patient group and call for intensive research in this field. Our aim was to assess the effect of CPAP treatment on sleep and overall life quality parameters, morbidity, and mortality in IPF patients with OSA.


Ninety-two treatment-naive, newly diagnosed, consecutive IPF patients underwent overnight-attended polysomnography (PSG). In those patients with an apnea-hypopnea index (AHI) of ≥15, therapy with CPAP was initiated. Patients were divided into poor and good CPAP compliance groups. All subjects completed multiple quality-of-life and sleep instruments before CPAP initiation and at 1 year after the start of CPAP treatment.


The good CPAP compliance group (37 patients) showed statistically significant improvement in all quality-of-life and sleep instruments after 1 year’s CPAP treatment. The poor CPAP compliance group (18 patients) showed significant changes of smaller strength only in a minority of the used instruments. During the 24-month follow-up period after CPAP initiation, three patients from the CPAP poor compliance group died, whereas all patients from the good CPAP compliance group remained alive.


Early OSA recognition and treatment is crucial in a fatal disease such as IPF. Effective CPAP treatment in IPF patients with OSA results in a significant improvement in daily living activities and quality of sleep and life. Good CPAP compliance appears to improve mortality.


Idiopathic pulmonary fibrosis Obstructive sleep apnea syndrome CPAP therapy Quality of life and sleep IPF mortality 


Conflict of interest

All the authors declare that they have no conflict of interest.


  1. 1.
    An Official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management (2011) Am J Respir Crit Care Med 183:788–824Google Scholar
  2. 2.
    Olson AL, Swigris JJ (2012) Idiopathic pulmonary fibrosis: diagnosis and epidemiology. Clin Chest Med 33:41–50CrossRefPubMedGoogle Scholar
  3. 3.
    Nathan SD, Shlobin OA, Weir N et al (2011) Long-term course and prognosis of idiopathic pulmonary fibrosis in the new millennium. Chest 140:221–229CrossRefPubMedGoogle Scholar
  4. 4.
    Mermigkis C, Chapman J, Golish J et al (2007) Sleep-related breathing disorders in patients with idiopathic pulmonary fibrosis. Lung 185:173–178CrossRefPubMedGoogle Scholar
  5. 5.
    Lancaster LH, Mason W, Parnell JA et al (2009) Obstructive sleep apnea is common in idiopathic pulmonary fibrosis. Chest 136:772–778CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Mermigkis C, Stagaki E, Tryfon S et al (2010) How common is sleep disordered breathing in patients with idiopathic pulmonary fibrosis. Sleep Breath 14:387–390CrossRefPubMedGoogle Scholar
  7. 7.
    Pihtili A, Bingol Z, Kiyan E et al (2013) Obstructive sleep apnea is common in patients with interstitial lung disease. Sleep Breath 17:1281–1288CrossRefPubMedGoogle Scholar
  8. 8.
    King C, Nathan SD (2013) Identification and treatment of co-morbidities in idiopathic pulmonary fibrosis and other fibrotic lung diseases. Curr Opin Pulm Med 19:466–473CrossRefPubMedGoogle Scholar
  9. 9.
    Mermigkis C, Stagaki E, Amfilochiou A et al (2009) Sleep quality and associated daytime consequences inpatients with idiopathic pulmonary fibrosis. Med Princ Pract 18:10–15CrossRefPubMedGoogle Scholar
  10. 10.
    Mermigkis C, Bouloukaki I, Schiza SE (2013) Obstructive sleep apnea in patients with interstitial lung diseases: past and future. Sleep Breath 17:1127–1128CrossRefPubMedGoogle Scholar
  11. 11.
    Agarwal S, Richardson B, Krishnan V et al (2009) Interstitial lung disease and sleep: what is known? Sleep Med 10:947–951CrossRefPubMedGoogle Scholar
  12. 12.
    Krishnan V, McCormack MC, Mathai SC et al (2008) Sleep quality and health-related quality of life in idiopathic pulmonary fibrosis. Chest 134:693–698CrossRefPubMedGoogle Scholar
  13. 13.
    De Vries J, Kessels BL, Drent M (2001) Quality of life ofidiopathic pulmonary fibrosis patients. Eur Respir J 17:954–961CrossRefPubMedGoogle Scholar
  14. 14.
    Swigris JJ, Kuschner WG, Jacobs SS et al (2005) Health-related quality of life in patients with idiopathic pulmonary fibrosis: a systematic review. Thorax 60:588–594CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Mermigkis C, Bouloukaki I, Antoniou K et al (2013) CPAP Therapy in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea. Does it offer a better quality of life and sleep? Sleep Breath 17:1137–1143CrossRefPubMedGoogle Scholar
  16. 16.
    Kolilekas L, Manali E, Vlami K et al (2013) Sleep oxygen desaturation predicts survival in idiopathic pulmonary fibrosis. J Clin Sleep Med 9:593–601PubMedCentralPubMedGoogle Scholar
  17. 17.
    Karakatsani A, Papakosta D, Rapti A, Hellenic Interstitial Lung Diseases Group et al (2009) Epidemiology of Interstitial lung diseases in Greece. Respir Med 103:1122–1129CrossRefPubMedGoogle Scholar
  18. 18.
    Iber C, Ancoli-Israel S, Chesson A, Quan SF, editors (2007) 1st ed. Westchester, IL: American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specificationGoogle Scholar
  19. 19.
    Kushida CA, Chediak A, Berry RB et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4:157–171PubMedGoogle Scholar
  20. 20.
    Mermigkis C, Mermigkis D, Varouchakis G, Schiza S (2012) CPAP treatment in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea-therapeutic difficulties and dilemmas. Sleep Breath 16:1–3CrossRefPubMedGoogle Scholar
  21. 21.
    Weaver TE, Laizner AM, Evans LK et al (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–843PubMedGoogle Scholar
  22. 22.
    Reimer MA, Flemons WW (2003) Quality of life in sleep disorders. Sleep Med Rev 7:335–349CrossRefPubMedGoogle Scholar
  23. 23.
    Gooneratne NS, Weaver TE, Cater JR et al (2003) Functional outcomes of excessive daytime sleepiness in older adults. J Am Geriatr Soc 51:642–649CrossRefPubMedGoogle Scholar
  24. 24.
    Buysse DJ, Reynolds CF, Monk TH et al (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213CrossRefPubMedGoogle Scholar
  25. 25.
    Backhaus J, Junghanns K, Broocks A et al (2002) Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 53:737–740CrossRefPubMedGoogle Scholar
  26. 26.
    Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45:5–13CrossRefPubMedGoogle Scholar
  27. 27.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMedGoogle Scholar
  28. 28.
    Hjollund N, Andersen J, Bech P (2007) Assessment of fatigue in chronic disease: a bibliographic study of fatigue measurement scales. Health Qual Life Outcome 27:5–12Google Scholar
  29. 29.
    Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123CrossRefPubMedGoogle Scholar
  30. 30.
    Ware JE Jr, Kosinski M, Bayliss MS et al (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 33:264–279CrossRefGoogle Scholar
  31. 31.
    Martinez TY, Pereira CA, dos Santos ML et al (2000) Evaluation of the short-form 36-item questionnaire to measure health related quality of life in patients with idiopathic pulmonary fibrosis. Chest 117:1627–1632CrossRefPubMedGoogle Scholar
  32. 32.
    Beck AT, Beamesderfer A (1974) Assessment of depression: the depression inventory. Mod Probl Pharmacopsychiatry 7:151–169PubMedGoogle Scholar
  33. 33.
    Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev 8:77–100CrossRefGoogle Scholar
  34. 34.
    American Thoracic Society (1995) Standardization of spirometry. Am J Respir Crit Care Med 152:1107–1136CrossRefGoogle Scholar
  35. 35.
    Lévy P, Pépin JL, Arnaud C et al (2008) Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives. Eur Respir J 32:1082–1095CrossRefPubMedGoogle Scholar
  36. 36.
    Neubauer JA (2001) Invited Review: Physiological and pathophysiological responses to intermittent hypoxia. J Appl Physiol 90:1593–1599PubMedGoogle Scholar
  37. 37.
    Mermigkis C, Kopanakis A, Foldvary-Schaefer N et al (2007) Health-related quality of life in patients with obstructive sleep apnoea and chronic obstructive pulmonary disease (overlap syndrome). Int J Clin Pract 61:207–211CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Charalampos Mermigkis
    • 1
    • 2
    • 3
    • 4
    Email author
  • Izolde Bouloukaki
    • 1
  • Katerina Antoniou
    • 1
  • Georgios Papadogiannis
    • 1
  • Ioannis Giannarakis
    • 1
  • Georgios Varouchakis
    • 3
  • Nikolaos Siafakas
    • 1
  • Sophia E. Schiza
    • 1
  1. 1.Sleep Disorders Unit, Department of Thoracic Medicine, University General HospitalMedical School of the University of CreteHeraklionGreece
  2. 2.Sleep Disorders Center401 General Army HospitalAthensGreece
  3. 3.Sleep Disorders CenterHenry Dunant HospitalAthensGreece
  4. 4.AthensGreece

Personalised recommendations