Purpose

Sleep-related breathing disorders (SRBD) may be associated with a worse prognosis in idiopathic pulmonary fibrosis (IPF). However, the prevalence of sleep disorders in IPF and the pathophysiological link between SRBD and IPF is unclear.

Patients and methods

In this prospective trial, consecutive patients with stable IPF underwent polysomnography and cardiopulmonary exercise testing. Epworth sleepiness scale, Regensburg insomnia scale, and Pittsburgh sleep quality index were evaluated. Exclusion criteria were oxygen supplementation therapy, lung emphysema, and heart failure. For pairwise comparison of categorical data, the two-proportion z-test was applied. Correlation between continuous variables was assessed via the Pearson correlation coefficient. Patients without and with SRBD were compared. To find predictors for SRBD in IPF, multivariable logistic regression was applied.

Results

A total of 74 IPF patients were evaluated and 45 patients (11 female, median age 74 years, forced vital capacity 71.3%, DLCO 53.9%) were analyzed. Any kind of sleep disorder was found in 89% of patients. SRBD was present in 49% (81% obstructive sleep apnea, 19% central sleep apnea), insomnia in 40%, and periodic leg movements in 47% of subjects.

The SRBD subgroup presented with a significantly lower performance (workload(peak)%pred 86.5 vs. 101.0 (p = 0.036); V′O₂(AT) 618.5 ml/min vs. 774.0 ml/min (p = 0.043)) and exhibited a significantly higher V′E/V′CO₂(peak) of 43.0 l/l vs. 38.5 l/l (p = 0.037). In search of predictors for SRBD by logistic regression, workload(peak)%pred was identified as a significant variable (p = 0.033).

Conclusions

SRBD is frequent in IPF. Pulmonary vascular limitations may represent the pathophysiological link between IPF and SRBD. Workload(peak)%pred may be an independent risk factor for the occurrence of SRBD.

中文翻译：

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特发性肺纤维化中睡眠相关的呼吸障碍很常见，可能与肺血管受累有关

目的

睡眠相关呼吸障碍 (SRBD) 可能与特发性肺纤维化 (IPF) 的预后较差有关。然而，IPF 中睡眠障碍的患病率以及 SRBD 和 IPF 之间的病理生理学联系尚不清楚。

患者和方法

在这项前瞻性试验中，连续的稳定 IPF 患者接受了多导睡眠图和心肺运动测试。评估了爱华嗜睡量表、雷根斯堡失眠量表和匹兹堡睡眠质量指数。排除标准为氧气补充治疗、肺气肿和心力衰竭。对于分类数据的成对比较，应用了双比例z检验。连续变量之间的相关性通过 Pearson 相关系数进行评估。比较没有和有 SRBD 的患者。为了在 IPF 中找到 SRBD 的预测因子，应用了多变量逻辑回归。

结果

共评估了 74 名 IPF 患者，并分析了 45 名患者（11 名女性，中位年龄 74 岁，用力肺活量 71.3%，DLCO 53.9%）。89% 的患者存在任何类型的睡眠障碍。49% 的受试者存在 SRBD（81% 的阻塞性睡眠呼吸暂停，19% 的中枢性睡眠呼吸暂停），40% 的受试者失眠，47% 的受试者存在周期性腿部运动。

SRBD 亚组的表现明显较低（工作负荷（峰值）%pred 86.5 与 101.0 ( p  = 0.036)；V'O ₂ (AT) 618.5 ml/min 与 774.0 ml/min ( p  = 0.043)）和表现出 43.0 l/l 与 38.5 l/l 的显着更高的 V'E/V'CO ₂（峰值）（p  = 0.037）。在通过逻辑回归寻找 SRBD 的预测因子时，工作量（峰值）%pred 被确定为重要变量 ( p  = 0.033)。

结论

SRBD 在 IPF 中很常见。肺血管限制可能代表 IPF 和 SRBD 之间的病理生理联系。Workload(peak)%pred可能是SRBD发生的独立危险因素。