Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
Respir Res. 2017 Nov 13;18(1):190. doi: 10.1186/s12931-017-0674-y.
The main symptoms of patients with idiopathic pulmonary fibrosis (IPF) are cough and dyspnea. IPF leads to a restrictive lung disorder impacting daytime and nocturnal breathing patterns. In this pilot study we assessed the course of day- and nighttime respiration, oxygenation, and cough over a period of 8 months as well as differences between wakefulness and sleep in IPF patients.
Repetitive 24-h respiratory polygraphies (RP) and pulmonary function tests were performed at baseline and after 3, 4, 7 and 8 months. Cough-index, oxygenation parameters (SpO2, time with SpO2 < 90%, desaturation index), respiratory rate and heart rate were assessed for differences between wakefulness and sleep. The first and the last RP were compared to identify changes of these parameters over time. Statistical analyses were performed with Wilcoxon signed rank tests.
Nine IPF patients (8 male, median age 67 years (IQR 60, 77) with 37 valid 24-h RPs were included. Eight patients (88.9%) received antifibrotic treatment. Cough was more prevalent during wakefulness with a median cough-index of 14.8/h (IQR 10.9, 16.8) and 1.6/h (IQR 1.3-2.8) during sleep, p = 0.0039. Oxygenation parameters showed no difference, while respiratory- and heart rate were significantly higher during wakefulness. Despite stable pulmonary function tests over 8 months, the initially elevated respiratory rate increased further during wakefulness (baseline RR median 25.7/min (IQR 19.8, 26.6) vs. RR median 32.2/min (IQR 26.5, 40.9) at follow-up, p = 0.0273). The other respiratory parameters remained stable over time.
Cough in IPF patients is more prevalent during wakefulness than during sleep. Further studies with a larger sample size and longer a follow-up period are needed to evaluate the role of the respiratory rate during wakefulness as a potential clinical follow up parameter in IPF.
特发性肺纤维化（IPF）患者的主要症状是咳嗽和呼吸困难。IPF 导致限制性肺疾病，影响白天和夜间的呼吸模式。在这项初步研究中，我们评估了 8 个月期间白天和夜间呼吸、氧合和咳嗽的过程，以及 IPF 患者在清醒和睡眠之间的差异。
在基线时以及在 3、4、7 和 8 个月后进行重复 24 小时呼吸描记术（RP）和肺功能检查。评估咳嗽指数、氧合参数（SpO2、SpO2<90%的时间、脱氧指数）、呼吸频率和心率在清醒和睡眠之间的差异。比较第一个和最后一个 RP，以确定这些参数随时间的变化。使用 Wilcoxon 符号秩检验进行统计分析。
纳入了 9 名 IPF 患者（8 名男性，中位年龄 67 岁（IQR 60，77），37 份有效 24 小时 RP）。8 名患者（88.9%）接受了抗纤维化治疗。咳嗽在清醒时更为常见，中位咳嗽指数为 14.8/h（IQR 10.9，16.8），睡眠时为 1.6/h（IQR 1.3-2.8），p=0.0039。氧合参数无差异，而呼吸和心率在清醒时明显较高。尽管 8 个月后肺功能检查稳定，但最初升高的呼吸率在清醒时进一步升高（基线 RR 中位数 25.7/min（IQR 19.8，26.6）与随访时 RR 中位数 32.2/min（IQR 26.5，40.9），p=0.0273）。其他呼吸参数随时间保持稳定。
与睡眠时相比，IPF 患者的咳嗽在清醒时更为常见。需要进一步的研究，包括更大的样本量和更长的随访时间，以评估清醒时呼吸率作为 IPF 潜在临床随访参数的作用。
