SESSION TITLE: Diffuse Lung Disease Global Case Reports
SESSION TYPE: Global Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease of unknown etiology which affects adult subjects between 60 and 75 years old. The average of survival time has a range between 2 to 5 years since diagnosis, but the progression rate and the size of damage could result unpredictable due to heterogeneity of the disease among individual patients. It has been previously described the presence of sleep disturbances in patients with lung fibrosis, moreover Lancaster have showed high prevalence of OSA in patients with IPF1. Even though polysomnogram (PSG) is considered the gold standard for OSA diagnosis, respiratory polygraphy (RP) has been also validated. With the aim to study presence of OSA in IPF population, we performed RP at home and analyzed differences between IPF patients with and without OSA.
CASE PRESENTATION: We included 17 stable out-patients with IPF diagnosis (2013 ATS/ERS consensus statement criteria). The mean of age was 66 ± 2.4 years old and 11 of them were males. All of them underwent to a RP; the anthropometric data, the epworth sleepiness scale (ESS), and the Berlin questionnaire were obtained. Patients were trained on the use and assembly of the RP devices, which were equipped with a pulse oximeter, effort belts and a high sensitive nasal pressure cannula. According to criteria established by the American Academy of Sleep Medicine AAMS in 2007, a respiratory event was defined as “apnea” when the nasal flow was reduced over 90% at least during 10 seconds and it was defined as “hypopnea” when the nasal flow was reduced over 50% associated with ≥ 3% of desaturation as minimum during 10 seconds. All recordings were downloaded and manually analyzed to get the scores. As average of total time of register was 5.85 hours, studies with less than 4 hours of records were excluded. We found 9 patients with OSA, 8 of them with mild to moderate OSA (5 ≥ IAH ≤ 15) and one with moderate to severe OSA (IAH= 24). OSA patients presented predominance of hypopneas, with an average of 11.73 ± 1.66 events/ hours. Our findings demonstrated that patients with OSA showed a significant increase in the oxygen desaturation index (ODI) compared IPF patients without OSA (18.78 ± 3.28 vs 5.87 ± 1.12 respectively; p<0.001). Nevertheless, Berlin and ESS questionnaires showed that patients were little symptomatic in both groups of patients. Body mass index (BMI) did not significant difference; the patients with OSA showed BMI = 30.15 ± 2.16 a while patients without OSA had BMI = 26.66 ± 1.60. We analyzed data of pulmonary functions (FVC, DLCO, TLC and FEV1) and of 6MWD test. No differences between patients with or without OSA were observed. Treatment with continuous airway pressure (CPAP) was indicated for our patient with IAH higher than 15. The rest of our patients remain without OSA treatment.
DISCUSSION: The prevalence of OSA in our IPF population was 52.9%. Our results are in according with previous data of Mermigkis and his colleagues2. They have suggested that OSA would be related with a poor sleep quality and with the rise in the exacerbations of IPF patients. It has been recently reported that CPAP-treatment from IPF patients, could improve the daily living activities. Moreover, a good CPAP compliance could be associated with decrease in the mortality rate of these patients3.
CONCLUSIONS: To conclude, diagnosis of OSA in IPF is important to determine the need of CPAP treatment. RP is a simple and useful tool to perform it diagnosis.
Reference #1: Obstructive sleep apnea is common in idiopathic pulmonary fibrosis. Lancaster LH, Mason WR, Parnell JA, Rice TW, Loyd JE, Milstone AP, Collard HR, Malow BA. Chest. 2009;136(3):772-8.
Reference #2: Sleep-related breathing disorders in patients with idiopathic pulmonary fibrosis.Mermigkis C, Chapman J, Golish J, Mermigkis D, Budur K, Kopanakis A, Polychronopoulos V, Burgess R, Foldvary-Schaefer N. Lung. 2007;185(3):173-8.
Reference #3: Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis. Mermigkis C, Bouloukaki I, Antoniou K, Papadogiannis G, Giannarakis I, Varouchakis G, Siafakas N, Schiza SE. Sleep Breath. 2015;19(1):385-91.
DISCLOSURE: The following authors have nothing to disclose: Glenda Ernst, Eduardo Borsini, Martín Bosio, Tamara Decima, Felipe Chertcoff, Silvia Quadrelli, Alejandro Salvado
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