Bosi Marcello, Milioli Giulia, Fanfulla Francesco, Tomassetti Sara, Ryu Jay H, Parrino Liborio, Riccardi Silvia, Melpignano Andrea, Vaudano Anna Elisabetta, Ravaglia Claudia, Tantalocco Paola, Rossi Andrea, Poletti Venerino
Department of Diseases of the Thorax, GB Morgagni Hospital, Asl Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy.
Sleep Disorders Center, Dept of Neurosciences, University of Parma, Parma, Italy.
Lung. 2017 Oct;195(5):643-651. doi: 10.1007/s00408-017-0031-4. Epub 2017 Jul 3.
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.
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).
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.
睡眠呼吸障碍（SBD）在特发性肺纤维化（IPF）中很常见，并且与睡眠和生活质量较差以及较高的死亡率相关。本研究旨在评估SBD对35例轻度至中度IPF患者预后（死亡率或疾病进展）的影响。
35例IPF患者中诊断出25例阻塞性睡眠呼吸暂停（OSA）：14例轻度，7例中度，4例重度。根据美国睡眠医学学会（AASM）的定义，35例IPF患者中有9例出现与睡眠相关的低氧血症。根据是否存在SBD，IPF患者分为4组：无SBD组（A组，25.7%）、无睡眠相关低氧血症的OSA组（B组，48.5%）、有睡眠相关低氧血症的OSA组（C组，22.8%），只有1/35例有与睡眠相关的低氧血症但无OSA（D组，2.8%）。统计分析仅集中在A、B和C组。患有阻塞性睡眠呼吸暂停低通气综合征（OSAS）和睡眠相关低氧血症的患者（C组）在死亡率或临床恶化方面预后最差。SBD是死亡率（HR 7.6%，IC 1.2 - 36.3；p = 0.029）和疾病进展（HR 9.95%，IC 1.8 - 644.9；p = 0.007）的唯一独立危险因素（Cox比例风险多元回归分析）。
SBD与较差的预后相关，无论是在死亡率还是临床进展方面。所有IPF患者均应检查是否存在SBD。
