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

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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.

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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

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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.

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Authors and Affiliations

  1. Department of Diseases of the Thorax, GB Morgagni Hospital, Asl Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy

    Marcello Bosi, Sara Tomassetti, Claudia Ravaglia, Paola Tantalocco & Venerino Poletti

  2. Sleep Disorders Center, Dept of Neurosciences, University of Parma, Parma, Italy

    Giulia Milioli, Liborio Parrino, Silvia Riccardi, Andrea Melpignano, Anna Elisabetta Vaudano & Venerino Poletti

  3. Sleep Medicine Unit and Sleep Research Laboratory S. Maugeri Foundation IRCCS – Scientific Insitute of Pavia, Pavia, Italy

    Francesco Fanfulla & Venerino Poletti

  4. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

    Jay H. Ryu, Andrea Rossi & Venerino Poletti

  5. Pulmonology Operative Unit, Verona University, Verona, Italy

    Venerino Poletti

  6. Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark

    Venerino Poletti

Authors
  1. Marcello Bosi
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  2. Giulia Milioli
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  7. Silvia Riccardi
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  8. Andrea Melpignano
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  9. Anna Elisabetta Vaudano
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  11. Paola Tantalocco
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  12. Andrea Rossi
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  13. Venerino Poletti
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Corresponding author

Correspondence to Marcello Bosi.

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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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Bosi, M., Milioli, G., Fanfulla, F. et al. OSA and Prolonged Oxygen Desaturation During Sleep are Strong Predictors of Poor Outcome in IPF. Lung 195, 643–651 (2017). https://doi.org/10.1007/s00408-017-0031-4

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  • DOI: https://doi.org/10.1007/s00408-017-0031-4

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