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. 2024 Jun 18;25(1):247.
doi: 10.1186/s12931-024-02871-6.

Treating sleep-disordered breathing of idiopathic pulmonary fibrosis patients with CPAP and nocturnal oxygen treatment. A pilot study : Sleep-disordered breathing treatment in IPF

Jaume Bordas-Martinez  1   2   3 , Neus Salord  2 , Vanesa Vicens-Zygmunt  1 , João Carmezim  4 , Sandra Pérez  2 , Eliseo Prado  2 , María Calvo  2 , Rosana Blavia  5 , Guadalupe Bermudo  1 , Salud Santos  1 , Carmen Monasterio #  6 , María Molina-Molina #  1
Affiliations

Treating sleep-disordered breathing of idiopathic pulmonary fibrosis patients with CPAP and nocturnal oxygen treatment. A pilot study : Sleep-disordered breathing treatment in IPF

Jaume Bordas-Martinez et al. Respir Res. .

Abstract

Introduction: Sleep-disordered breathing (SDB) is a major comorbidity in idiopathic pulmonary fibrosis (IPF) and is associated with a poor outcome. There is a lack of knowledge regarding the impact of SDB treatment on IPF. We assessed at one year: (1) the effect of CPAP and/or nocturnal oxygen therapy on IPF regarding lung function, blood mediators, and quality of life; (2) adherence to SDB treatment and SDB changes.

Methodology: This is a prospective study of consecutive newly diagnosed IPF patients initiating anti-fibrotic treatment. Lung function, polysomnography, blood tests and quality of life questionnaires were performed at inclusion and after one year. Patients were classified as obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and sleep-sustained hypoxemia (SSH). SDB therapy (CPAP and/or nocturnal oxygen therapy) was initiated if needed.

Results: Fifty patients were enrolled (36% had OSA, 22% CSA, and 12% SSH). CPAP was started in 54% of patients and nocturnal oxygen therapy in 16%. At one-year, polysomnography found improved parameters, though 17% of patients had to add nocturnal oxygen therapy or CPAP, while 33% presented SDB onset at this second polysomnography. CPAP compliance at one year was 6.74 h/night (SD 0.74). After one year, matrix metalloproteinase-1 decreased in OSA and CSA (p = 0.029; p = 0.027), C-reactive protein in OSA (p = 0.045), and surfactant protein D in CSA group (p = 0.074). There was no significant change in lung function.

Conclusions: Treatment of SBD with CPAP and NOT can be well tolerated with a high compliance. IPF patients may exhibit SDB progression and require periodic re-assessment. Further studies to evaluate the impact of SDB treatment on lung function and serological mediators are needed.

Keywords: Apnoea; Biomarkers; CPAP; Hypoxemia; Idiopathic pulmonary fibrosis; Sleep; Supplemental oxygen therapy.

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Conflict of interest statement

The authors declare no competing interests.

The authors state that they have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Proposal for the treatment of sleep-disordered breathing in patients with idiopathic pulmonary fibrosis. OSA: obstructive sleep apnoea; CSA: central sleep apnoea; AHI: apnoea-hypopnea index; TST88: total sleep time under SpO2 88%; CPAP: continuous positive airway pressure; O2: supplemental oxygen
Fig. 2
Fig. 2
Blood biological mediators at baseline and at one year by type of SBD. Outsider values were excluded. OSA: obstructive sleep apnoea; CSA: central sleep apnoea; SSH: sleep-sustained hypoxemia; No- SDB: No sleep-disordered breathing; MMP-1: matrix metalloproteinase 1; SP-D: surfactant protein D ; CRP: C-reactive protein
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