Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  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 183:788–824

  2. Olson AL, Swigris JJ (2012) Idiopathic pulmonary fibrosis: diagnosis and epidemiology. Clin Chest Med 33:41–50

    Article  PubMed  Google Scholar 

  3. Nathan SD, Shlobin OA, Weir N et al (2011) Long-term course and prognosis of idiopathic pulmonary fibrosis in the new millennium. Chest 140:221–229

    Article  PubMed  Google Scholar 

  4. Mermigkis C, Chapman J, Golish J et al (2007) Sleep-related breathing disorders in patients with idiopathic pulmonary fibrosis. Lung 185:173–178

    Article  PubMed  Google Scholar 

  5. Lancaster LH, Mason W, Parnell JA et al (2009) Obstructive sleep apnea is common in idiopathic pulmonary fibrosis. Chest 136:772–778

    Article  PubMed Central  PubMed  Google Scholar 

  6. Mermigkis C, Stagaki E, Tryfon S et al (2010) How common is sleep disordered breathing in patients with idiopathic pulmonary fibrosis. Sleep Breath 14:387–390

    Article  PubMed  Google Scholar 

  7. Pihtili A, Bingol Z, Kiyan E et al (2013) Obstructive sleep apnea is common in patients with interstitial lung disease. Sleep Breath 17:1281–1288

    Article  PubMed  Google Scholar 

  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 19:466–473

    Article  PubMed  Google Scholar 

  9. Mermigkis C, Stagaki E, Amfilochiou A et al (2009) Sleep quality and associated daytime consequences inpatients with idiopathic pulmonary fibrosis. Med Princ Pract 18:10–15

    Article  CAS  PubMed  Google Scholar 

  10. Mermigkis C, Bouloukaki I, Schiza SE (2013) Obstructive sleep apnea in patients with interstitial lung diseases: past and future. Sleep Breath 17:1127–1128

    Article  PubMed  Google Scholar 

  11. Agarwal S, Richardson B, Krishnan V et al (2009) Interstitial lung disease and sleep: what is known? Sleep Med 10:947–951

    Article  PubMed  Google Scholar 

  12. Krishnan V, McCormack MC, Mathai SC et al (2008) Sleep quality and health-related quality of life in idiopathic pulmonary fibrosis. Chest 134:693–698

    Article  PubMed  Google Scholar 

  13. De Vries J, Kessels BL, Drent M (2001) Quality of life ofidiopathic pulmonary fibrosis patients. Eur Respir J 17:954–961

    Article  PubMed  Google Scholar 

  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 60:588–594

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  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 17:1137–1143

    Article  PubMed  Google Scholar 

  16. Kolilekas L, Manali E, Vlami K et al (2013) Sleep oxygen desaturation predicts survival in idiopathic pulmonary fibrosis. J Clin Sleep Med 9:593–601

    PubMed Central  PubMed  Google Scholar 

  17. Karakatsani A, Papakosta D, Rapti A, Hellenic Interstitial Lung Diseases Group et al (2009) Epidemiology of Interstitial lung diseases in Greece. Respir Med 103:1122–1129

    Article  CAS  PubMed  Google Scholar 

  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 specification

  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 4:157–171

    PubMed  Google Scholar 

  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 16:1–3

    Article  PubMed  Google Scholar 

  21. Weaver TE, Laizner AM, Evans LK et al (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–843

    CAS  PubMed  Google Scholar 

  22. Reimer MA, Flemons WW (2003) Quality of life in sleep disorders. Sleep Med Rev 7:335–349

    Article  PubMed  Google Scholar 

  23. Gooneratne NS, Weaver TE, Cater JR et al (2003) Functional outcomes of excessive daytime sleepiness in older adults. J Am Geriatr Soc 51:642–649

    Article  PubMed  Google Scholar 

  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 28:193–213

    Article  CAS  PubMed  Google Scholar 

  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 53:737–740

    Article  PubMed  Google Scholar 

  26. Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45:5–13

    Article  CAS  PubMed  Google Scholar 

  27. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    CAS  PubMed  Google Scholar 

  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 27:5–12

    Google Scholar 

  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 46:1121–1123

    Article  CAS  PubMed  Google Scholar 

  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 33:264–279

    Article  Google Scholar 

  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 117:1627–1632

    Article  CAS  PubMed  Google Scholar 

  32. Beck AT, Beamesderfer A (1974) Assessment of depression: the depression inventory. Mod Probl Pharmacopsychiatry 7:151–169

    CAS  PubMed  Google Scholar 

  33. Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev 8:77–100

    Article  Google Scholar 

  34. American Thoracic Society (1995) Standardization of spirometry. Am J Respir Crit Care Med 152:1107–1136

    Article  Google Scholar 

  35. Lévy P, Pépin JL, Arnaud C et al (2008) Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives. Eur Respir J 32:1082–1095

    Article  PubMed  Google Scholar 

  36. Neubauer JA (2001) Invited Review: Physiological and pathophysiological responses to intermittent hypoxia. J Appl Physiol 90:1593–1599

    CAS  PubMed  Google Scholar 

  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 61:207–211

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

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

Author information

Authors and Affiliations

  1. Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece

    Charalampos Mermigkis, Izolde Bouloukaki, Katerina Antoniou, Georgios Papadogiannis, Ioannis Giannarakis, Nikolaos Siafakas & Sophia E. Schiza

  2. Sleep Disorders Center, 401 General Army Hospital, Athens, Greece

    Charalampos Mermigkis

  3. Sleep Disorders Center, Henry Dunant Hospital, Athens, Greece

    Charalampos Mermigkis & Georgios Varouchakis

  4. Thrakis 61A, Vrilissia, Athens, Greece

    Charalampos Mermigkis

Authors
  1. Charalampos Mermigkis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Izolde Bouloukaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katerina Antoniou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georgios Papadogiannis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ioannis Giannarakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Georgios Varouchakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nikolaos Siafakas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sophia E. Schiza
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charalampos Mermigkis.

Additional information

Charalampos Mermigkis and Izolde Bouloukaki made equal contributions to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mermigkis, C., Bouloukaki, I., Antoniou, K. et al. Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis. Sleep Breath 19, 385–391 (2015). https://doi.org/10.1007/s11325-014-1033-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-014-1033-6

Keywords

Search

Navigation