Marcello Bosi1, Giulia Milioli2, Francesco Fanfulla3, Sara Tomassetti4, Jay H Ryu5, Liborio Parrino2, Silvia Riccardi2, Andrea Melpignano2, Anna Elisabetta Vaudano2, Claudia Ravaglia4, Paola Tantalocco4, Andrea Rossi5, Venerino Poletti4,2,3,5,6,7. 1. Department of Diseases of the Thorax, GB Morgagni Hospital, Asl Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy. marcello.bosi@libero.it. 2. Sleep Disorders Center, Dept of Neurosciences, University of Parma, Parma, Italy. 3. Sleep Medicine Unit and Sleep Research Laboratory S. Maugeri Foundation IRCCS - Scientific Insitute of Pavia, Pavia, Italy. 4. Department of Diseases of the Thorax, GB Morgagni Hospital, Asl Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy. 5. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. 6. Pulmonology Operative Unit, Verona University, Verona, Italy. 7. Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark.
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.
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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