Abstract

TABAJ, Gabriela et al. Frecuency of sleep related disorders in patients with diffuse lung diseases. Rev. amer. med. respiratoria [online]. 2013, vol.13, n.1, pp.12-18. ISSN 1852-236X.

Background: Patients with interstitial lung disease (ILD) often have sleep fragmentation with frequent arousals. In this group of patients, nocturnal oxygen desaturation is common, with a prevalence of 50-80%. It is worse in Rapid Eye Movement (REM) sleep, is associated with reduced quality of life and can contribute to long-term vascular damage. The presence of obstructive sleep apnea (OSA) occurs in 20% of the general adult population. Aims: To describe the characteristics of clinical and physiological respiratory parameters and frequency of respiratory sleep disorders (RSD), especially OSA, in patients with ILD. Materials and Methods: We prospectively included ILD patients who attended a specialized hospital between July 2010 and January 2012. Polysomnography (PSG) and study of pulmonary function: Forced Vital Capacity (FVC) and Diffusing Lung Capacity for Carbon Monoxide (DLCO) were performed. Results: We studied 41 patients with a mean age of 61.5 ± 12.6 years. 54% were male (n = 22). ILD diagnoses were usual interstitial pneumonia (UIP) in 70.7%, nonspecific interstitial pneumonia (NSIP) in 14.6%, hypersensitivity pneumonitis (HP) in 9.8% and pulmonary alveolar proteinosis (PAP) in 4.8%. The body mass index (BMI) was 29.4 ± 4.4 kg/m²; it was = 25 in 80% of patients and = 30 in 41%. The mean FVC was 2.18 ± 0.7 l and 64.8 ± 16.8 in the percentage of predictive value. The DLCO adjusted to Hb mean was 10.3 ± 3.6 ml/mmHg/min and 46.9 ± 14 in the percentage of predictive value. Regarding the PSG, the mean baseline SpO₂ was 93.9 ± 3.4%, the mean saturation during sleep was 89.8 ± 7%, and the mean SpO₂ was < 90% in 39% of cases. In 90% of cases the minimum SpO₂ during sleep was less than 90%; 34% of patients had CT 90 (time with SpO2 < 90%) > 50%. In 13 patients with baseline SpO₂ > 95%, 3 had CT90 = 20% and 10 of the 27 patients with basal SpO₂ > 92%, had CT90 = 20%. Of all patients, 48.8% had OSA. The mean apnea-hypopnea index (AHI) was 11.4 and 20% of patients had AHI = 15. Regarding the Epworth Sleepiness Scale (ESS), 45% of patients with OSA had a = 10 ESS, which was significantly higher compared to the group without OSA. In the group of patients with AHI = 15, 62.5% had ESS < 10. Conclusions: A significant number of patients without resting hypoxemia presented desaturation during sleep. In this study, the frequency of AOS was 48.8%. In addition, the group of patients with OSA had higher oximetry involvement measured through CT90

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