Section of Pulmonary & Critical Care, Department of Medicine, The University of Chicago, Chicago, IL.
Section of Pulmonary & Critical Care, Department of Medicine, The University of Chicago, Chicago, IL; Sleep Disorders Center, Department of Medicine, The University of Chicago, Chicago, IL.
Chest. 2020 Oct;158(4):1701-1712. doi: 10.1016/j.chest.2020.04.067. Epub 2020 May 22.
OSA, a common comorbidity in interstitial lung disease (ILD), could contribute to a worsened course if untreated. It is unclear if adherence to CPAP therapy improves outcomes.
Does adherence to CPAP therapy improve outcomes in patients with concurrent interstitial lung disease and OSA?
We conducted a 10-year retrospective observational multicenter cohort study, assessing adult patients with ILD who had undergone polysomnography. Subjects were categorized based on OSA severity into no/mild OSA (apnea-hypopnea index score < 15) or moderate/severe OSA (apnea-hypopnea index score ≥ 15). All subjects prescribed and adherent to CPAP were deemed to have treated OSA. Cox regression models were used to examine the association of OSA severity and CPAP adherence with all-cause mortality risk and progression-free survival (PFS).
Of 160 subjects that met inclusion criteria, 131 had OSA and were prescribed CPAP. Sixty-six patients (41%) had no/mild untreated OSA, 51 (32%) had moderate/severe untreated OSA, and 43 (27%) had treated OSA. Subjects with no/mild untreated OSA did not differ from those with moderate/severe untreated OSA in mean survival time (127 ± 56 vs 138 ± 93 months, respectively; P = .61) and crude mortality rate (2.9 per 100 person-years vs 2.9 per 100 person-years, respectively; P = .60). Adherence to CPAP was not associated with improvement in all-cause mortality risk (hazard ratio [HR], 1.1; 95% CI, 0.4-2.9; P = .79) or PFS (HR, 0.9; 95% CI, 0.5-1.5; P = .66) compared with those that were nonadherent or untreated. Among subjects requiring supplemental oxygen, those adherent to CPAP had improved PFS (HR, 0.3; 95% CI, 0.1-0.9; P = .03) compared with nonadherent or untreated subjects.
Neither OSA severity nor adherence to CPAP was associated with improved outcomes in patients with ILD except those requiring supplemental oxygen.
阻塞性睡眠呼吸暂停低通气综合征（OSA）是间质性肺疾病（ILD）的常见合并症，如果不治疗，可能会导致病情恶化。目前尚不清楚 CPAP 治疗的依从性是否能改善预后。
ILD 合并 OSA 患者对 CPAP 治疗的依从性是否能改善预后？
我们进行了一项为期 10 年的回顾性多中心队列研究，评估了接受过多导睡眠图检查的ILD 成年患者。根据 OSA 严重程度，受试者分为无/轻度 OSA（呼吸暂停低通气指数评分<15）或中/重度 OSA（呼吸暂停低通气指数评分≥15）。所有接受 CPAP 治疗并坚持治疗的患者被认为是治疗了 OSA。Cox 回归模型用于检查 OSA 严重程度和 CPAP 依从性与全因死亡率风险和无进展生存率（PFS）的关系。
在符合纳入标准的 160 名患者中，有 131 名患有 OSA 并接受 CPAP 治疗。66 名患者（41%）患有未经治疗的无/轻度 OSA，51 名患者（32%）患有未经治疗的中/重度 OSA，43 名患者（27%）患有经治疗的 OSA。无/轻度未经治疗的 OSA 患者的中位生存时间（127±56 个月与 138±93 个月，分别；P=0.61）和粗死亡率（2.9/100 人年与 2.9/100 人年，分别；P=0.60）与中/重度未经治疗的 OSA 患者无差异。CPAP 治疗的依从性与全因死亡率风险（风险比[HR]，1.1；95%CI，0.4-2.9；P=0.79）或 PFS（HR，0.9；95%CI，0.5-1.5；P=0.66）的改善均无相关性，与不依从或未经治疗的患者相比。在需要补充氧气的患者中，与不依从或未经治疗的患者相比，CPAP 治疗依从性好的患者 PFS 改善（HR，0.3；95%CI，0.1-0.9；P=0.03）。
除了需要补充氧气的患者外，ILD 患者的 OSA 严重程度或 CPAP 治疗的依从性与预后改善均无关。
