Simonson Joseph L, Pandya Dhwani, Khan Sarah, Verma Sameer, Greenberg Harly E, Talwar Arunabh
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 410 Lakeville Road, Suite 107, New Hyde Park, NY, 10040, USA.
Department of Medicine, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA.
Sleep Breath. 2022 Dec;26(4):1711-1715. doi: 10.1007/s11325-021-02555-1. Epub 2022 Jan 7.
Sleep disturbance is common in patients with advanced interstitial lung disease (ILD) often complicated by pulmonary hypertension (PH) and may contribute to poor quality of life. The etiology of sleep disturbance and the relationship between PH and sleep architecture in patients with ILD remains unknown.
We performed a retrospective cohort study comparing sleep architecture on polysomnography in patients with ILD with and without PH, defined as mean pulmonary artery pressure on right heart catheterization ≥ 20 mmHg. We tested the hypothesis that patients with ILD and PH would have increased wake time after sleep onset (WASO) compared to patients with ILD without PH using univariate analysis and multivariable linear regression.
In our cohort of patients with ILD who underwent polysomnography (N = 49), patients with PH had lower total diffusion capacity for carbon monoxide (DLCO) (9.28 vs. 12.87 ml/min/mmHg, P = 0.04) and percent DLCO (39% vs. 53%, P = 0.03). On polysomnography, patients with PH had increased percentage of total sleep time with saturation < 90% (T90) (17% vs. 6%, P = 0.03), decreased N2 sleep (181 vs. 233 min, P = 0.03), decreased %N2 sleep (59% vs. 66%, P = 0.04), increased %N1 sleep (22% vs. 14%, P = 0.02), decreased sleep efficiency (62% vs. 72%, P = 0.03), and increased WASO (133 vs. 84 min, P = 0.01). In multivariable analysis, PH was associated with a 43-min increase in WASO (95% CI 6.2-80.2, P = 0.02).
Patients with ILD and PH have decreased total and %N2 sleep, increased %N1 sleep, decreased sleep efficiency, and increased WASO, likely indicating increased sleep fragmentation.
睡眠障碍在晚期间质性肺疾病（ILD）患者中很常见，常并发肺动脉高压（PH），并可能导致生活质量下降。ILD患者睡眠障碍的病因以及PH与睡眠结构之间的关系仍不清楚。
我们进行了一项回顾性队列研究，比较了有和没有PH的ILD患者在多导睡眠图上的睡眠结构，PH定义为右心导管检查时平均肺动脉压≥20 mmHg。我们使用单变量分析和多变量线性回归检验了以下假设：与没有PH的ILD患者相比，患有ILD和PH的患者睡眠开始后的清醒时间（WASO）会增加。
在我们接受多导睡眠图检查的ILD患者队列（N = 49）中，患有PH的患者一氧化碳总弥散量（DLCO）较低（9.28 vs. 12.87 ml/min/mmHg，P = 0.04）和DLCO百分比（39% vs. 53%，P = 0.03）。在多导睡眠图上，患有PH的患者总睡眠时间中饱和度<90%（T90）的百分比增加（17% vs. 6%，P = 0.03），N2睡眠减少（181 vs. 233分钟，P = 0.03），N2睡眠百分比降低（59% vs. 66%，P = 0.04），N1睡眠百分比增加（22% vs. 14%，P = 0.02），睡眠效率降低（62% vs. 72%，P = 0.03），以及WASO增加（133 vs. 84分钟，P = 0.01）。在多变量分析中，PH与WASO增加43分钟相关（95% CI 6.2 - 80.2，P = 0.02）。
患有ILD和PH的患者总睡眠和N2睡眠百分比降低，N1睡眠百分比增加，睡眠效率降低，WASO增加，这可能表明睡眠碎片化增加。
