Mermigkis Charalampos, Bouloukaki Izolde, Schiza Sophia E
Sleep Disorders Center, Henry Dunant Hospital, Athens; Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece.
Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece.
Chest. 2017 Dec;152(6):1327-1338. doi: 10.1016/j.chest.2017.07.019. Epub 2017 Aug 1.
Idiopathic pulmonary fibrosis (IPF) is the most common type of interstitial pneumonia but remains a disease with a poor outcome. Two drugs, pirfenidone and nintedanib, have shown promising results at stalling disease progression; however, the interplay of sleep disruption or sleep disorders overall and in relation to medication effectiveness remains understudied. In the past, there was limited interest in the role of sleep in patients with IPF. Treating physicians tended to address only the daily disabling symptoms while disregarding the possible significant role of sleep alterations or coexisting sleep disorders. During the past few years, there has been more research related to sleep disturbances in patients with IPF and their possible role in sleep and overall life quality, disease progression, and outcome. In summary, sleep in patients with IPF is significantly impaired, with alterations in sleep architecture, changes in sleep breathing pattern, and decreases in oxygen saturation mainly during vulnerable rapid eye movement sleep. There also is evidence that OSA has an increased prevalence in these patients, playing an important role in the already worse sleep quality related to the disease itself. The focus of this review is not only to present current data related to sleep in patients with IPF but also to point out that therapy for sleep problems and OSA is likely to improve sleep and life quality as well as disease outcome. The main priority remains to increase awareness among treating physicians about early diagnosis of OSA in patients with IPF and to emphasize the need for intense future research, especially on the role of intermittent hypoxia superimposed on chronic hypoxia during sleep in patients with IPF.
特发性肺纤维化（IPF）是间质性肺炎最常见的类型，但仍是一种预后较差的疾病。两种药物，吡非尼酮和尼达尼布，已显示出在延缓疾病进展方面有令人鼓舞的结果；然而，睡眠中断或整体睡眠障碍及其与药物疗效的相互作用仍未得到充分研究。过去，人们对IPF患者睡眠的作用兴趣有限。治疗医生往往只关注日常的致残症状，而忽视睡眠改变或并存睡眠障碍可能具有的重要作用。在过去几年里，有更多关于IPF患者睡眠障碍及其在睡眠和整体生活质量、疾病进展及预后中可能作用的研究。总之，IPF患者的睡眠受到显著损害，睡眠结构改变、睡眠呼吸模式变化，且主要在易受影响的快速眼动睡眠期间氧饱和度下降。也有证据表明这些患者阻塞性睡眠呼吸暂停（OSA）的患病率增加，在与疾病本身相关的本就较差的睡眠质量中起重要作用。本综述的重点不仅是呈现与IPF患者睡眠相关的当前数据，还指出睡眠问题和OSA的治疗可能会改善睡眠和生活质量以及疾病预后。主要优先事项仍然是提高治疗医生对IPF患者中OSA早期诊断的认识，并强调未来进行深入研究的必要性，特别是关于IPF患者睡眠期间间歇性低氧叠加在慢性低氧上的作用。
