Nocturnal hypoxaemia is associated with adverse outcomes in interstitial lung disease

Abstract

Background and objective Sleep‐disordered breathing (SDB) has been reported as highly prevalent in idiopathic pulmonary fibrosis (IPF) and other interstitial lung disease (ILD) populations. Nocturnal oxygen desaturation (NOD), or the total sleep time spent with SpoO2 < 90% (TST < 90), can occur both with and without associated apnoeas, and is common in ILD. This study aimed to characterize abnormal SDB and extent of TST < 90 in ILD patients and evaluate relationships between TST < 90 and markers of disease severity, development of pulmonary hypertension (PH) and mortality. Methods Consecutive, newly referred ILD patients attending a specialist clinic underwent polysomnography (PSG). Serial lung function tests, echocardiography and other clinical variables were recorded. Predictors of PH and mortality were evaluated using logistic regression and Cox proportional hazards regression analyses. Results A total of 92 ILD patients (including 44 with IPF) underwent PSG. At least mild obstructive sleep apnoea (OSA) was observed in 65.2%, with rapid eye movement (REM)‐related events occurring frequently. At least 10% TST < 90 (designated ‘significant NOD’) was present in 35.9% of patients, and was associated with PH at baseline echocardiography. Multiple indices of hypoxaemia during sleep, including significant NOD, predicted the development of new or worsening PH. TST < 90 predicted overall and progression‐free survival. Conclusion Nocturnal oxygen saturation is associated with poorer prognosis in ILD patients and may contribute towards the pathogenesis of pulmonary vascular disease.

Obstructive sleep apnea in patients with interstitial lung disease: Prevalence and predictive factors

“…In recent studies, OSA and hypoxemia have been shown to correlate with disease-related mortality in ILD patients [34]. In a prospective, single-cohort study of 31 IPF patients, Kolilekas et al reported that the lowest category of SpO 2 correlated directly with survival (HR 0.897, 95% CI: 0.827-0.972, p = 0.009), but AHI did not.…”

Oxygen therapy in COPD and interstitial lung disease: navigating the knowns and unknowns

“…The prevalence of nocturnal hypoxaemia in patients with COPD and ILD varies from 27% to 70% [36][37][38][39] and 36% to 57% [40][41][42][43], respectively. In addition to the variations in criteria used to define nocturnal hypoxaemia in these studies, the presence of coexisting sleep disordered breathing may also impact on its prevalence.…”

“…In both conditions, nocturnal hypoxaemia is only loosely related to daytime resting or exertional hypoxaemia and does not correlate with the degree of lung function impairment [37,39,41]. There have been studies that suggest a potential association of nocturnal hypoxaemia with pulmonary hypertension in patients with COPD and ILD [41,[43][44][45]. However, the presence of sleep disordered breathing, a common comorbidity in patients with both conditions [46][47][48], was not evaluated in the majority of these studies.…”

Terapias adyuvantes a la terapia antifibrótica en la fibrosis pulmonar idiopática. Importancia del manejo multidisciplinario

“…Parece relevante considerar las desaturación de oxígeno nocturna: valores mayores a un 10% del tiempo total del sueño con saturación de o 2 < 90% está asociado al desarrollo de enfermedad vascular pulmonar. Estos hallazgos resaltan la necesidad de realizar estudios nocturnos de oxigenoterapia para evaluar los efectos sobre la HAP y la mortalidad de sujetos con FPI con desaturaciones de oxígeno nocturnas 45 . Aunque es necesaria la evaluación caso a caso y la disponibilidad de recursos, dado la escases de evidencia clínica en esta área.…”