title: Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis.
abstract: OBJECTIVE
  The most recent idiopathic pulmonary fibrosis (IPF) guidelines include obstructive sleep apnea (OSA) among the IPF-associated comorbidities. Furthermore, they recognize the paucity of studies related to continuous positive airway pressure(CPAP) treatment in this patient group and call for intensive research in this field. Our aim was to assess the effect of CPAP treatment on sleep and overall life quality parameters, morbidity, and mortality in IPF patients with OSA.
  
  
  METHODS
  Ninety-two treatment-naive, newly diagnosed, consecutive IPF patients underwent overnight-attended polysomnography (PSG). In those patients with an apnea-hypopnea index (AHI) of ≥15, therapy with CPAP was initiated. Patients were divided into poor and good CPAP compliance groups. All subjects completed multiple quality-of-life and sleep instruments before CPAP initiation and at 1 year after the start of CPAP treatment.
  
  
  RESULTS
  The good CPAP compliance group (37 patients) showed statistically significant improvement in all quality-of-life and sleep instruments after 1 year's CPAP treatment. The poor CPAP compliance group (18 patients) showed significant changes of smaller strength only in a minority of the used instruments. During the 24-month follow-up period after CPAP initiation, three patients from the CPAP poor compliance group died, whereas all patients from the good CPAP compliance group remained alive.
  
  
  CONCLUSIONS
  Early OSA recognition and treatment is crucial in a fatal disease such as IPF. Effective CPAP treatment in IPF patients with OSA results in a significant improvement in daily living activities and quality of sleep and life. Good CPAP compliance appears to improve mortality.
authors.affiliation: Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece, mermigh@gmail.com.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Mermigkis
authors.forename: Izolde
authors.initials: I
authors.lastname: Bouloukaki
authors.forename: Katerina
authors.initials: K
authors.lastname: Antoniou
authors.forename: Georgios
authors.initials: G
authors.lastname: Papadogiannis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Giannarakis
authors.forename: Georgios
authors.initials: G
authors.lastname: Varouchakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Siafakas
authors.forename: Sophia E
authors.initials: SE
authors.lastname: Schiza
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications* / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*