Obstructive Sleep Apnea Is Common in Idiopathic Pulmonary Fibrosis
Obstructive Sleep Apnea Is Common in Idiopathic Pulmonary Fibrosis
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DOI：
10.1378/chest.08-2776
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发表时间：
2009-09-01
期刊：
影响因子：
9.6
通讯作者：
Malow, Beth A.
中科院分区：
文献类型：
--
作者：
Lancaster, Lisa H.;Mason, Wendi R.;Malow, Beth A.
背景：1984年至2006年，对间质性肺病患者睡眠的研究显示睡眠紊乱、夜间频繁血氧饱和度下降、夜间咳嗽以及阻塞性睡眠呼吸暂停（OSA）。我们的目的是分析特发性肺纤维化（IPF）稳定期门诊患者中的阻塞性睡眠呼吸暂停情况。
方法：范德比尔特肺科诊所随访的特发性肺纤维化患者被邀请参与研究。所有患者均依据2000年美国胸科学会共识声明标准被诊断为特发性肺纤维化。受试者在接受夜间多导睡眠监测（NPSG）之前完成一份爱泼沃斯嗜睡量表（ESS）问卷和一份睡眠障碍问卷中的睡眠呼吸暂停量表（SA - SDQ）。阻塞性睡眠呼吸暂停定义为呼吸暂停 - 低通气指数（AHI）>每小时5次事件。
结果：50名受试者入组并完成夜间多导睡眠监测。平均年龄为64.9岁，平均体重指数（BMI）为32.3。88%的受试者被诊断为阻塞性睡眠呼吸暂停。10名受试者（20%）患有轻度阻塞性睡眠呼吸暂停（AHI，每小时5 - 15次事件），34名受试者（68%）患有中 - 重度阻塞性睡眠呼吸暂停（AHI，>每小时15次事件）。只有6名受试者（12%）呼吸暂停 - 低通气指数正常。1名患者依据爱泼沃斯嗜睡量表和睡眠呼吸暂停量表判定无症状，但呼吸暂停 - 低通气指数为每小时24次事件。爱泼沃斯嗜睡量表的敏感度为75%，特异度为15%，而睡眠呼吸暂停量表的敏感度为88%，特异度为50%。体重指数与呼吸暂停 - 低通气指数无强相关性（r = 0.30；p = 0.05）。
结论：阻塞性睡眠呼吸暂停在特发性肺纤维化患者中普遍存在，可能未被初级医疗服务提供者和专科医生充分认识。爱泼沃斯嗜睡量表和睡眠呼吸暂停量表无论是单独使用还是联合使用都不是一种有效的筛查工具。鉴于我们样本中发现的高患病率，特发性肺纤维化患者应考虑进行正规的睡眠评估和多导睡眠监测。（《胸部》2009年；136卷：772 - 778页）
Background: From 1984 to 2006, studies of sleep in patients with interstitial lung disease revealed disturbed sleep, frequent nocturnal desaturations, nocturnal cough, and obstructive sleep apnea (OSA). Our goal was to analyze OSA in an outpatient population of stable patients with idiopathic pulmonary fibrosis (IPF).Methods: Patients with IPF who had been followed up in the Vanderbilt Pulmonary Clinic were asked to participate. All patients were given a diagnosis of IPF by the 2000 American Thoracic Society consensus statement criteria. Subjects completed an Epworth sleepiness scale (ESS) questionnaire and a sleep apnea scale of sleep disorders questionnaire (SA-SDQ) before undergoing nocturnal polysomnography (NPSG). OSA was defined as an apnea-hypopnea index (AHI) of > 5 events per hour.Results: Fifty subjects enrolled and completed a NPSG. The mean age was 64.9 years, and the mean BMI was 32.3. OSA was diagnosed in 88% of subjects. Ten subjects (20%) bad mild OSA (AHI, 5 to 15 events per hour), and 34 subjects (68%) had moderate-to-severe OSA (AHI, > 15 events per hour). Only 6 subjects (12%) had a normal AHI. One patient was asymptomatic as determined by ESS and SA-SDQ, but had an AHI of 24 events per hour. The sensitivity of the ESS was 75% with a specificity of 15%, whereas the SA-SDQ had a sensitivity of 88% with a specificity of 50%. BMI did not correlate strongly with AHI (r = 0.30; p = 0.05).Conclusions: OSA is prevalent in patients with IPF and may be underrecognized by primary care providers and specialists. Neither ESS nor SA-SDQ alone or in combination was a strong screening tool. Given the high prevalence found in our sample, formal sleep evaluation and polysomnography should be considered in patients with IPF. (CHEST 2009; 136:772-778)