Effects of antifibrotic treatment on sleep quality and polysomnography parameters in patients with idiopathic pulmonary fibrosis

Our study aimed to evaluate the effects of antifibrotic treatment on sleep quality, fatigue level and polysomnographic parameters in patients with Idiopathic Pulmonary Fibrosis. It is known that sleep disorders are an important comorbidity in patients with Idiopathic Pulmonary Fibrosis. No study investigating the effects of antifibrotic treatments on sleep quality and polysomnographic parameters was found in the literature. The mean age of 52 Idiopathic Pulmonary Fibrosis patients included in the study was 69.13±8.48 years, and 75% of the patients were male. In the history characteristics, 14 patients (27%) were found to have family history of interstitial lung disease. 43 of the patients (82.7%) were interpreted as usual interstitial pneumonia, and the rest as possible usual interstitial pneumonia. The mean Pittsburgh Sleep Quality Index score of the patients before treatment was found to be 17. This value shows that the subjective sleep quality of the patients is significantly impaired. The median score of the Fatigue Severity Scale was found to be 5, indicating that fatigue negatively affects daily activities. In the polysomnography results of 51 patients evaluated before treatment; median sleep efficiency was 88.2%; Stage 3 was 22.5%; Rapid Eye Movement sleep was 17.67%; Apnea Hypopnea Index was 7; mean oxygen saturation was 92.37% and the lowest oxygen saturation was 82.33%. While Apnea Hypopnea Index was ≥5/hour in 23 (45%) of our patients, Apnea Hypopnea Index was ≥15/hour in 11 (21.6%). The remarkable finding of the study was obtained by evaluating 20 patients (nine patients nintedanib, 11 patients pirfenidone) who could be controlled with polysomnography after six months of antifibrotic treatment. While sleep efficiency, mean saturation and mean Rapid Eye Movement sleep saturation parameters deteriorated after treatment; an increase was detected in Wake Time After Sleep Onset and Stage 1 parameters. At the same time, Pittsburgh Sleep Quality Index deteriorated. When the correlation between the results of post-treatment polysomnography and the results of the questionnaire tests in patients who could undergo control polysomnography was examined; a significant correlation was observed with the Epworth Sleepiness Scale and Apnea Hypopnea Index duration, the longest Apnea Hypopnea Index duration, and mean desaturation parameters. A positive correlation was observed with the Fatigue Severity Scale and the percentage of time with oxygen saturation <90% and mean pulse parameters. In addition, a negative correlation was observed with mean saturation; mean Rapid Eye Movement sleep saturation and mean Non-Rapid Eye Movement sleep saturation parameters. In conclusion, this study showed that subjective sleep quality was significantly impaired in patients with Idiopathic Pulmonary Fibrosis, fatigue was a significant symptom, and the prevalence of obstructive sleep apnea was high. Negative changes were detected in some sleep parameters and subjective sleep quality after antifibrotic treatment. Screening, diagnosis and appropriate treatment of sleep disorders are important in the comprehensive management of patients with Idiopathic Pulmonary Fibrosis.