From the Department of Respiratory Medicine, St. Vincent's University Hospital, School of Medicine and Medical Science, University College Dublin, Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland From the Department of Respiratory Medicine, St. Vincent's University Hospital, School of Medicine and Medical Science, University College Dublin, Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland.
From the Department of Respiratory Medicine, St. Vincent's University Hospital, School of Medicine and Medical Science, University College Dublin, Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland.
QJM. 2015 Apr;108(4):315-23. doi: 10.1093/qjmed/hcu175. Epub 2014 Sep 23.
Idiopathic pulmonary fibrosis (IPF) patients report fatigue, possibly reflecting sleep disturbance, but little is known about sleep-related changes. We compared ventilation and gas exchange during sleep and exercise in a cohort of IPF patients, and evaluated associations with selected biological markers.
Twenty stable IPF patients (aged 67.9 ± 12.3 [SD]) underwent overnight polysomnography following an acclimatization night. Cardiopulmonary exercise testing was performed and inflammatory markers measured including TNF-α, IL-6, CXCL8, C-C motif ligand 18 (CCL-18) and C-reactive protein (CRP) RESULTS: Nine patients had sleep-disordered breathing (SDB) with an apnea-hypopnea frequency (AHI) ≥ 5/h, but only two had Epworth sleepiness score ≥ 10, thus having an obstructive sleep apnea syndrome. Sleep quality was poor. Transcutaneous carbon dioxide tension (PtcCO2) rose by 2.56 ± 1.59 kPa overnight (P = 0.001), suggesting hypoventilation. Oxygen saturation (SaO2) was lower during sleep than exercise (P < 0.01), and exercise variables correlated with resting pulmonary function. CCL-18 and CRP levels were elevated and correlated with PtcCO2 rise during sleep (P < 0.05). CCL-18 negatively correlated with diffusion capacity of carbon monoxide (DLCO), arterial oxygen (PaO2) and mean arterial carbon dioxide (PaCO2) (P < 0.05) and CRP negatively correlated with DLCO, PaO2, sleep SaO2 and oxygen uptake (VO2) during exercise (P < 0.05).
IPF patients desaturate more during sleep than exercise; thus, nocturnal pulse oxymetry could be included in clinical assessment. CCL-18 and CRP levels correlate with physiological markers of fibrosis.
特发性肺纤维化（IPF）患者报告疲劳，可能反映了睡眠障碍，但对于与睡眠相关的变化知之甚少。我们比较了一组 IPF 患者的睡眠和运动期间的通气和气体交换，并评估了与选定生物标志物的关联。
20 名稳定的 IPF 患者（年龄 67.9 ± 12.3[SD]）在适应过夜后进行了整夜多导睡眠图检查。进行了心肺运动测试，并测量了炎症标志物，包括 TNF-α、IL-6、CXCL8、C 型趋化因子配体 18（CCL-18）和 C 反应蛋白（CRP）。
9 名患者有睡眠呼吸障碍（SDB），呼吸暂停低通气指数（AHI）≥5/小时，但只有 2 名患者的嗜睡评分≥10，因此患有阻塞性睡眠呼吸暂停综合征。睡眠质量差。夜间经皮二氧化碳分压（PtcCO2）升高 2.56 ± 1.59 kPa（P=0.001），提示通气不足。睡眠时的血氧饱和度（SaO2）低于运动时（P<0.01），并且运动变量与静息肺功能相关。CCL-18 和 CRP 水平升高，并与睡眠期间 PtcCO2 升高相关（P<0.05）。CCL-18 与一氧化碳弥散量（DLCO）、动脉血氧（PaO2）和平均动脉二氧化碳（PaCO2）呈负相关（P<0.05），CRP 与 DLCO、PaO2、睡眠时 SaO2 和摄氧量（VO2）呈负相关在运动期间（P<0.05）。
与运动相比，IPF 患者在睡眠期间饱和度下降更多；因此，夜间脉搏血氧仪可以包含在临床评估中。CCL-18 和 CRP 水平与纤维化的生理标志物相关。
