Obstructive sleep apnea in patients with interstitial lung diseases: past and future
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EDITORIAL (INVITED)
Obstructive sleep apnea in patients with interstitial lung diseases: past and future Charalampos Mermigkis & Izolde Bouloukaki & Sophia E. Schiza
Received: 27 January 2013 / Accepted: 22 March 2013 # Springer-Verlag Berlin Heidelberg 2013
In their article published in this issue of Sleep and Breathing, Pihtili et al. [1] present polysomnographic data in patients with interstitial lung diseases (ILDs) including 17 patients with idiopathic pulmonary fibrosis (IPF), 15 patients with stage II–III sarcoidosis, and 18 patients with pulmonary fibrosis due to scleroderma. The study revealed a high prevalence, namely 68 %, of obstructive sleep apnea (OSA) in this population. The prevalence of OSA was 82.3 % in the IPF patients, 66.6 % in the sarcoidosis patients, and 55.5 % in the scleroderma patients. The OSA severity was mostly mild, while the scored respiratory events were predominantly hypopneas. An interesting feature of this study is that this increased incidence of OSA was observed after the exclusion of patients with well-known predisposing factors for OSA such as obesity and/or significant upper airway pathologies causing obstruction. The authors used a disease severity index consisting of body mass index, carbon monoxide diffusion capacity, the Modified Medical Research Council dyspnea scale, and the 6-min walking distance, with scores ranging between 0 and 10. The OSA diagnosis rate was higher in the patients who had severity index ≥3.
C. Mermigkis Sleep Disorders Center, 401 General Army Hospital, Athens, Greece C. Mermigkis : I. Bouloukaki : S. E. Schiza Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Crete, Greece C. Mermigkis (*) Thrakis 61A, Vrilissia, Athens, Greece e-mail: [email protected]
The frequency and consequences of OSA in patients with interstitial lung diseases is a field of growing research over the last years, although the medical literature on this area still remains quite limited with significant contraries between the results of older and more recent studies [2]. Prior polysomnographic studies in the mid-1980s demonstrated alterations in sleep architecture and oxygen desaturation, especially during REM sleep, but not OSA, even in morbidly obese patients with ILDs [3, 4]. The results of the study by Pihtili et al. related to IPF patients are similar to recent studies that report increased incidence of OSA and pointed the need for high clinical suspicion for possible underlying OSA in this population [5–8]. Prior studies dating back 10–20 years probably underestimated hypopneas by using only thermal sensors and not nasal pressure transducers which are recognized as the sensitive devices for hypopnea detection that represents the majority of the observed respiratory events in IPF patients based on the newer studies. Related to sarcoidosis, Pihtili et al. report significantly higher percentages of OSA compared to previous studies [9] while the only one published study in scleroderma [10] found
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