PDF(Pubmed)
Abstract：
BACKGROUND: Sleep-disordered breathing (SDB) is a major comorbidity in idiopathic pulmonary fibrosis (IPF) and is associated with a poor outcome. There is a lack of knowledge regarding the impact of SDB treatment on IPF. We assessed at one year: (1) the effect of CPAP and/or nocturnal oxygen therapy on IPF regarding lung function, blood mediators, and quality of life; (2) adherence to SDB treatment and SDB changes.
METHODS: This is a prospective study of consecutive newly diagnosed IPF patients initiating anti-fibrotic treatment. Lung function, polysomnography, blood tests and quality of life questionnaires were performed at inclusion and after one year. Patients were classified as obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and sleep-sustained hypoxemia (SSH). SDB therapy (CPAP and/or nocturnal oxygen therapy) was initiated if needed.
RESULTS: Fifty patients were enrolled (36% had OSA, 22% CSA, and 12% SSH). CPAP was started in 54% of patients and nocturnal oxygen therapy in 16%. At one-year, polysomnography found improved parameters, though 17% of patients had to add nocturnal oxygen therapy or CPAP, while 33% presented SDB onset at this second polysomnography. CPAP compliance at one year was 6.74 h/night (SD 0.74). After one year, matrix metalloproteinase-1 decreased in OSA and CSA (p = 0.029; p = 0.027), C-reactive protein in OSA (p = 0.045), and surfactant protein D in CSA group (p = 0.074). There was no significant change in lung function.
CONCLUSIONS: Treatment of SBD with CPAP and NOT can be well tolerated with a high compliance. IPF patients may exhibit SDB progression and require periodic re-assessment. Further studies to evaluate the impact of SDB treatment on lung function and serological mediators are needed.
METHODS: This is a prospective study of consecutive newly diagnosed IPF patients initiating anti-fibrotic treatment. Lung function, polysomnography, blood tests and quality of life questionnaires were performed at inclusion and after one year. Patients were classified as obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and sleep-sustained hypoxemia (SSH). SDB therapy (CPAP and/or nocturnal oxygen therapy) was initiated if needed.
RESULTS: Fifty patients were enrolled (36% had OSA, 22% CSA, and 12% SSH). CPAP was started in 54% of patients and nocturnal oxygen therapy in 16%. At one-year, polysomnography found improved parameters, though 17% of patients had to add nocturnal oxygen therapy or CPAP, while 33% presented SDB onset at this second polysomnography. CPAP compliance at one year was 6.74 h/night (SD 0.74). After one year, matrix metalloproteinase-1 decreased in OSA and CSA (p = 0.029; p = 0.027), C-reactive protein in OSA (p = 0.045), and surfactant protein D in CSA group (p = 0.074). There was no significant change in lung function.
CONCLUSIONS: Treatment of SBD with CPAP and NOT can be well tolerated with a high compliance. IPF patients may exhibit SDB progression and require periodic re-assessment. Further studies to evaluate the impact of SDB treatment on lung function and serological mediators are needed.
摘要：
背景：睡眠呼吸紊乱（SDB）是特发性肺纤维化（IPF）的主要合并症，并与不良预后相关。缺乏关于SDB治疗对IPF的影响的知识。我们在一年时评估：（1）CPAP和/或夜间氧疗对IPF肺功能的影响，血液介质,和生活质量；（2）对SDB治疗的依从性和SDB变化。
方法：这是一项针对开始抗纤维化治疗的连续新诊断IPF患者的前瞻性研究。肺功能,多导睡眠图,纳入时和1年后进行血液检查和生活质量问卷调查.患者被归类为阻塞性睡眠呼吸暂停（OSA），中枢睡眠呼吸暂停（CSA），和睡眠持续性低氧血症（SSH）。如果需要,开始SDB治疗(CPAP和/或夜间氧疗)。
结果：纳入50例患者（36%患有OSA，22%CSA，和12%SSH）。54%的患者开始CPAP，16%的患者开始夜间氧疗。一年，多导睡眠图发现了改善的参数，尽管17%的患者必须增加夜间氧疗或CPAP，而33%的人在第二次多导睡眠监测时出现SDB发作。一年的CPAP依从性为6.74h/night（SD0.74）。一年后,基质金属蛋白酶-1在OSA和CSA中降低(p=0.029;p=0.027),OSA中的C反应蛋白（p=0.045），CSA组表面活性蛋白D(p=0.074)。肺功能无明显变化。
结论：用CPAP和NOT治疗SBD具有良好的耐受性和高依从性。IPF患者可能表现出SDB进展，需要定期重新评估。需要进一步的研究来评估SDB治疗对肺功能和血清学介质的影响。
方法：这是一项针对开始抗纤维化治疗的连续新诊断IPF患者的前瞻性研究。肺功能,多导睡眠图,纳入时和1年后进行血液检查和生活质量问卷调查.患者被归类为阻塞性睡眠呼吸暂停（OSA），中枢睡眠呼吸暂停（CSA），和睡眠持续性低氧血症（SSH）。如果需要,开始SDB治疗(CPAP和/或夜间氧疗)。
结果：纳入50例患者（36%患有OSA，22%CSA，和12%SSH）。54%的患者开始CPAP，16%的患者开始夜间氧疗。一年，多导睡眠图发现了改善的参数，尽管17%的患者必须增加夜间氧疗或CPAP，而33%的人在第二次多导睡眠监测时出现SDB发作。一年的CPAP依从性为6.74h/night（SD0.74）。一年后,基质金属蛋白酶-1在OSA和CSA中降低(p=0.029;p=0.027),OSA中的C反应蛋白（p=0.045），CSA组表面活性蛋白D(p=0.074)。肺功能无明显变化。
结论：用CPAP和NOT治疗SBD具有良好的耐受性和高依从性。IPF患者可能表现出SDB进展，需要定期重新评估。需要进一步的研究来评估SDB治疗对肺功能和血清学介质的影响。
