Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis

Abstract

Early OSA recognition and treatment is crucial in a fatal disease such as IPF. Effective CPAP treatment in IPF patients with OSA results in a significant improvement in daily living activities and quality of sleep and life. Good CPAP compliance appears to improve mortality.

Cough in idiopathic pulmonary fibrosis

“…GORD, on the other hand, may promote OSA, through microaspiration of gastric substances, creating an inflammatory reaction blocking the airway [53]. GORD, chronic cough and, as recently shown, IPF can be improved by treatment of OSA [49,51]. Figure 2 shows the interplay between IPF, GORD, OSA and cough.…”

“…OSA itself, with intermittent hypoxaemia, may promote profibrotic mechanisms [49]. In the general population, chronic cough is more prevalent in OSA and can be improved by treatment with continuous positive airway pressure (CPAP) [50].…”

“…1: traction leading to a weaker lower oesophageal sphincter tonus [45]; 2: microaspiration inducing epithelial damage [38,46]; 3: restriction inducing instability of the upper airway [39]; 4: intermitted hypoxaemia promoting profibrotic mechanisms [49]; 5: increased cough reflex sensitivity [22][23][24][25][26][27][28][29][30][31]; 6: pressure causing stretch injury and activation of fibrotic mechanisms [31]; 7: microaspiration causing an inflammatory reaction blocking the airway [53]; 8: obstruction increasing trans-diaphragmatic pressure [51,52]; 9: aspiration directly and acid reflux indirectly stimulate the cough reflex [6,47]; 10: cough increasing trans-diaphragmatic pressure [47]; 11: less central inhibition and inflammation increasing cough reflex sensitivity [54]. sensory nerves.…”

Idiopathic pulmonary fibrosis and sleep disorders: no longer strangers in the night

“…Even though it was interesting and they were all alive at the reporting of the study, one could speculate that CPAP might have offered a survival benefit. In a very recent multicentre study by MERMIGKIS et al [34], CPAP therapy was initiated in 92 treatment-naïve, newly diagnosed, consecutive IPF patients with moderate-to-severe OSA. Patients were divided into a poor and a good CPAP compliance group.…”

Insomnia and excessive daytime sleepiness in obstructive sleep apnea: only different clinical phenotypes?

“…Another crucial point related to insomnia in patients with OSA is the occurrence other respiratory and cardiac comorbidities such as cardiac failure, respiratory diseases with obstructive or restrictive pattern such as chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF) that are also characterized by the disabling symptom of insomnia irrespective of OSA coexistence [17,18]. In addition, insomnia may have direct or indirect effects on CPAP adherence in these patients.…”