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Review
. 2025 Mar 24;14(7):2205.
doi: 10.3390/jcm14072205.

The Link Between Sleep-Related Breathing Disorders and Idiopathic Pulmonary Fibrosis: Pathophysiological Mechanisms and Treatment Options-A Review

Athina Patsoura  1 , Giulia Baldini  1 , Daniele Puggioni  1 , Matteo Delle Vergini  1 , Ivana Castaniere  1   2 , Dario Andrisani  1   2   3 , Filippo Gozzi  1   2   3 , Anna Valeria Samarelli  2 , Giulia Raineri  2 , Sofia Michelacci  1 , Cristina Ruini  1 , Andrea Carzoli  1 , Aurelia Cuculo  1 , Alessandro Marchioni  1   2 , Bianca Beghè  1 , Enrico Clini  1   2   3 , Stefania Cerri  1   2   3 , Roberto Tonelli  1   2   3
Affiliations
Review

The Link Between Sleep-Related Breathing Disorders and Idiopathic Pulmonary Fibrosis: Pathophysiological Mechanisms and Treatment Options-A Review

Athina Patsoura et al. J Clin Med. .

Abstract

In recent years, several studies have examined the impact of sleep-disordered breathing (SBD) on the quality of life and prognosis of patients with idiopathic pulmonary fibrosis (IPF). Among these disorders, obstructive sleep apnea (OSA) and nocturnal hypoxemia (NH) are the most prevalent and extensively studied, whereas central sleep apnea (CSA) has only been documented in recent research. The mechanisms underlying the relationship between IPF and SBDs are complex and remain an area of active investigation. Despite growing recognition of SBDs in IPF, no standardized guidelines exist for their management and treatment, particularly in a population characterized by distinct structural pulmonary abnormalities. This review outlines the pathophysiological connections between sleep-breathing disorders (SBDs) and idiopathic pulmonary fibrosis (IPF), as well as current therapeutic options. A comprehensive literature search using PubMed identified relevant studies, confirming the efficacy of CPAP in treating severe OSA and CSA. While high-flow oxygen therapy has not been validated in this patient cohort, it may offer a potential solution for select patients, particularly the elderly and those with low compliance. Conventional oxygen therapy, however, is limited to cases of isolated nocturnal hypoxemia or mild central sleep apnea.

Keywords: central sleep apnea; continuous positive airway pressure; conventional oxygen therapy; high-flow nasal cannula; idiopathic pulmonary fibrosis; nocturnal hypoxemia; obstructive sleep apnea; sleep breathing disorders.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Primary SBDs identified in patients with IPF and the pathophysiological mechanisms underlying their development. SBDs: Sleep Breathing Disorders IPF: Idiopathic Pulmonary Fibrosis, OSA: Obstructive Sleep Apnea, CSA: Central Sleep Apnea, NH: Nocturnal Hypoxemia.
Figure 2
Figure 2
Proposal for a flowchart of treatment options for different sleep breathing disorders in patients with IPF. IPF: Idiopathic Pulmonary Fibrosis, OSA: Obstructive Sleep Apnea, CSA: Central Sleep Apnea, NH: Nocturnal Hypoxemia, HFNC: High-Flow Nasal Cannula, CPAP: Continuous Positive Airway Pressure, COT: Conventional Oxygen Therapy.
See this image and copyright information in PMC

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