First Description of the Hyperpnea–Hypopnea Periodic Breathing in Patients with Interstitial Lung Disease-Obstructive Sleep Apnea: Treatment Implications in a Real-Life Setting

Abstract

There is evidence that hypopneas are more common than apneas in obstructive sleep apnea (OSA) related to idiopathic pulmonary fibrosis (IPF). We investigated the frequency distribution of hypopneas in 100 patients with interstitial lung diseases (ILDs) (mean age 69 yrs ± 7.8; 70% males), including 54 IPF cases, screened for OSA by home sleep testing. Fifty age- and sex-matched pure OSA patients were included as controls. In ILD-OSA patients the sleep breathing pattern was characterized by a high prevalence of hypopneas that were preceded by hyperpnea events configuring a sort of periodic pattern. This finding, we arbitrarily defined hyperpnea–hypopnea periodic breathing (HHPB), was likely reflecting a central event and was completely absent in control OSA. Also, the HHPB was highly responsive to oxygen but not to the continuous positive pressure support. Thirty-three ILD-OSA patients (42%) with a HHPB associated with a hypopnea/apnea ratio ≥3 had the best response to oxygen with a median residual AHI of 2.6 (1.8–5.6) vs. 28.3 (20.7–37.8) at baseline (p < 0.0001). ILD-OSA patients with these characteristics were similarly distributed in IPF (54.5%) and no-IPF cases (45.5%), the most of them being affected by moderate–severe OSA (p = 0.027). Future studies addressing the pathogenesis and therapy management of the HHPB should be encouraged in ILD-OSA patients.

Periodic breathing during hypoxia altitude simulation test

“…It can be triggered by hypoxaemia and hypocapnia occurring during sleep, altitude exposure, stroke, heart failure 3 and interstitial lung disease. 4 This phenomenon has previously been described in hypobaric hypoxia during exercise 5 and sleep 6 and, experimentally, in normobaric hypoxia in healthy young adults and athletes. 7 8 Guidelines indicate supplemental oxygen if there is a fall in SpO 2 below 85% or the use of continuous positive airway pressure (CPAP) devices in patients with already diagnosed sleep disturbances requiring them.…”

“…In a recent report of patients with obstructive sleep apnoea related to IPF, oxygen rather than CPAP was more effective for treating periodic breathing. 4 The present report pictures periodic breathing during a diagnostic normobaric HAST at rest in an IPF patient. This finding could predict its manifestation during a commercial flight, where we found no data on its occurrence.…”

Prognostic Significance of Obstructive Sleep Apnea in a Population of Subjects with Interstitial Lung Diseases

“…Several studies have found that OSA is common in subjects with IPF and ILD [ 10 – 37 ]. Some findings of prospective studies, including ours, on the prevalence of OSA in IPF and ILD populations are presented in Table 4 [ 15 , 16 , 18 , 22 – 28 , 30 , 32 – 37 ]. This search was not systematic, but includes all the studies (with sample size > ten subjects) reported in a recent systematic review on the topic [ 47 ].…”

Treatment of idiopathic pulmonary fibrosis and progressive pulmonary fibrosis: A position statement from the Thoracic Society of Australia and New Zealand 2023 revision

“…Hypopnoea is more common than apnoeas in patients with IPF/ILD, with the hypothesis that some are more vulnerable to sleep‐related ventilatory control instability (enhanced loop gain) due to chronic hypoxaemia 131 . Patients exhibiting the enhanced loop gain endotype (rather than predominantly upper airway collapse endotype) may respond to oxygen supplementation during sleep rather than CPAP, however, further research is needed 132 OSA and nocturnal hypoxaemia occur frequently in patients with IPF and other fibrotic lung diseases.…”