title: CPAP therapy in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea: does it offer a better quality of life and sleep?
abstract: BACKGROUND
  The recent literature shows an increased incidence of obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF). On the other hand, there are no published studies related to continuous positive airway pressure (CPAP) treatment in this patient group. Our aim was to assess the effect of CPAP on sleep and overall life quality parameters in IPF patients with OSA and to recognize and overcome possible difficulties in CPAP initiation and acceptance by these patients.
  
  
  METHODS
  Twelve patients (ten males and two females, age 67.1 ± 7.2 years) with newly diagnosed IPF and moderate to severe OSA, confirmed by overnight attended polysomnography, were included. Therapy with CPAP was initiated after a formal in-lab CPAP titration study. The patients completed the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes in Sleep Questionnaire (FOSQ), the Fatigue Severity Scale (FSS), the SF-36 quality of life questionnaire, and the Beck Depression Inventory (BDI) at CPAP initiation and after 1, 3, and 6 months of effective CPAP therapy.
  
  
  RESULTS
  A statistically significant improvement was observed in the FOSQ at 1, 3, and 6 months after CPAP initiation (baseline 12.9 ± 2.9 vs. 14.7 ± 2.6 vs. 15.8 ± 2.1 vs. 16.9 ± 1.9, respectively, p = 0.02). Improvement, although not statistically significant, was noted in ESS score (9.2 ± 5.6 vs. 7.6 ± 4.9 vs. 7.5 ± 5.3 vs. 7.7 ± 5.2, p = 0.84), PSQI (10.7 ± 4.4 vs. 10.1 ± 4.3 vs. 9.4 ± 4.7 vs. 8.6 ± 5.2, p = 0.66), FSS (39.5 ± 10.2 vs. 34.8 ± 8.5 vs. 33.6 ± 10.7 vs. 33.4 ± 10.9, p = 0.44), SF-36 (63.2 ± 13.9 vs. 68.9 ± 13.5 vs. 72.1 ± 12.9 vs. 74.4 ± 11.3, p = 0.27), and BDI (12.9 ± 5.5 vs. 10.7 ± 4.3 vs. 9.4 ± 4.8 vs. 9.6 ± 4.5, p = 0.40). Two patients had difficulty complying with CPAP for a variety of reasons (nocturnal cough, claustrophobia, insomnia) and stopped CPAP use after the first month, despite intense follow-up by the CPAP clinic staff. Heated humidification was added for all patients in order to improve the common complaint of disabling nocturnal cough.
  
  
  CONCLUSIONS
  Effective CPAP treatment in IPF patients with OSA results in a significant improvement in daily living activities based on the FOSQ, namely an OSA-specific follow-up instrument. Improvement was also noted in other questionnaires assessing quality of life, though not to a statistically significant degree, probably because of the multifactorial influences of IPF on physical and mental health. The probability of poor CPAP compliance was high and could only be eliminated with intense follow-up by the CPAP clinic staff.
authors: Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece, mermigh@gmail.com.
authors: Charalampos
authors: C
authors: Mermigkis
authors: Izolde
authors: I
authors: Bouloukaki
authors: Katerina M
authors: KM
authors: Antoniou
authors: Demetrios
authors: D
authors: Mermigkis
authors: Kostas
authors: K
authors: Psathakis
authors: Ioannis
authors: I
authors: Giannarakis
authors: Georgios
authors: G
authors: Varouchakis
authors: Nikolaos
authors: N
authors: Siafakas
authors: Sophia E
authors: SE
authors: Schiza
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D045422:Continuous Positive Airway Pressure; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011658:Pulmonary Fibrosis / Q000175:diagnosis* / Q000628:therapy*; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
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