Wednesday, July 16, 2014

Does Sleep Apnea Cause Pulmonary Fibrosis? Help me found out...

I have a theory. I believe that sleep apnea causes idiopathic pulmonary fibrosis. Maybe not in everyone -- and there are definitely other risk factors that contribute to IPF. But I believe it.

Here's why:


It might surprise you, but upwards of 90% of adults with IPF have sleep apnea. Only about 25% of middle-aged men and 9% of women have sleep apnea. This link between IPF and sleep apnea doesn't prove anything, but if sleep apnea were a cause of IPF, this is what you would expect to find.

There are a lot of reasons to think that untreated sleep apnea might injure lung tissue, including excessive stretching of lung tissue, low oxygen levels during sleep, and worsening of acid reflux. Sleep apnea happens dozens of times each hour...every night...for years. Even if only a little bit of injury happens each night, it can build up over a lifetime. And injured lung tissue can heal with scar tissue in people at risk for IPF.

I discussed the connection between sleep apnea and IPF in a 20 minute lecture I gave at the Pulmonary Fibrosis Foundation Summit in La Jolla in December of 2013. You can download my slides here. I have also written about the connection between sleep apnea and IPF in a brief letter I published in 2012 and in a small research study I published in 2009. Dr. Kevin Leslie has also written about this theory, although without referring specifically to sleep apnea.

So, it makes sense that sleep apnea might contribute to the risk of IPF, but no one has ever studied whether treating sleep apnea helps the lungs in people with IPF. Sounds simple, but it takes money to do this. Over the past few months, I've been designing a clinical trial to help us find out if sleep apnea contributes to lung injury and scarring in idiopathic pulmonary fibrosis. Now we need to raise the money. Please take a look at our video and read a summary of the clinical trial at Consano.org, where you can donate money to support our project. If you would rather not donate money, please consider sharing the Consano.org site with your friends and family by email or on Facebook, Twitter, or other social media websites.

Please help me make a difference.

Thanks
Dave Lederer

20 comments :

  1. Very interesting theory, Dr. Lederer. I have autoimmune PF and have been told I have sleep apnea. I spent two nights (weeks apart) at a Sleep Study facility and didn't sleep a wink either night. They tried different masks on me but because I toss and turn a lot, I kept knocking the mask out of position allowing the air to escape. Since they did not collect enough data on me they wanted me back for a third night. I said No Thanks to that and the delivery of the CPAP to my house. I didn't feel that I could ever sleep with any sort of apparatus on my face. My question is, do you think by NOT using the CPAP I could be accelerating the PF disease process? My lung function has declined rapidly this past year. If you thought my using the CPAP might help slow the progression of the PF, I might be convinced to try it again. Thank you again for this blog.

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    1. I don't know if treating PF (IPF or any PF) with CPAP is helpful. I wish I had a good answer for you. We need to study the effect of CPAP on the lungs in PF in order to figure this out. Many people initially have difficulty with the masks, but with patience, most people find a mask (many of which do not look or feel at all like a "mask") that they can tolerate. Don't give up! You might find that after sleeping with the right "mask" for a few nights, you feel better during the day! Good luck and sorry for the late reply.

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  2. Is it only the correlation between sleep apnea and IPF that has been documented? What about other sleep disorders such as Restless Leg Syndrome? I've been diagnosed for almost 20 years with RLS and interestingly when I started oxygen therapy my RLS symptoms virtually disappeared immediately and I now sleep as I did in my 20s and 30s. I think I need to consider increased my oxygen flow rate at night from 2 lpm since for the last month or so I'm no longer waking up as naturally and refreshed as I was. When I was in my 20s and 30s my sleep cycle seemed to be closely tied to the daylight hours. I could seldom sleep in once it was light outside and to get a restful sleep it had to be during the darkness of night.

    I do have the 3rd member of the IPF triumvirate: GERD

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    1. Hi Barbara. Great thoughts. I think there is a lot more we need to learn about the link between sleep and IPF.

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  3. Fascinating correlation. I was dx with sleep apnea about 4 years ago and IPF in May this year by biopsy. I think the lowest my blood oxygen got during the study was 83%. This theory makes a LOT of sense.

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  4. Really interesting. Do you think we investigate possible OSA enough in IPF? As a respiratory nurse working primary with people with COPD and ILD in the UK it feels as thought the crossover with COPD is better recognised? Would be interesting to see if OSA treatments could slow progression?

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    1. Hi Sandra. I look very hard for OSA in my patients with IPF. I think health care providers should be routinely looking into whether their IPF patients have OSA. Thanks for sharing your thoughts!

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  5. Hi Doc,
    I have been using a CPAP for about 4 years. I have PF from CHP. My PFT"s are somewhat stable over the those years with slight decline but HRCT done every year show increasing scarring. I use my CPAP every night but will nap during the day without it for about a hour. You think that that hour a day could be causing the increase in scar tissue?? Thank, Dave

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    1. Right now, I don't think we really have any hard proof that untreated sleep apnea contributes to scarring in the lung. When our clinical trial of CPAP in IPF is completed, we hope we will be able to show that treatment with CPAP helps to prevent injury of lung tissue during sleep. If we can prevent lung injury, then there ought to be less scarring.

      Talk to your doctor about whether or not you should be using CPAP during your nap. Many doctors recommend using your CPAP during naps.

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  6. Hi Doc,

    I have sleep apnea and use a CPAP with some success. I was diagnosed about 5 years ago and this year was diagnosed with IPF. I wake up fatigued every day and am curious do you think the apnea or the IPF would be the primary cause. I'm going back to the sleep Dr. next week to discuss how to get more rest because I'm always exhausted.

    Thanks for all you do, your work is so helpful.

    m

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    1. Hi Mike. Thanks for your question. Waking up fatigued is very common in sleep apnea. It's possible that low oxygen levels from IPF during sleep could also contribute to fatigue in the morning. Have you had sleep apnea for a long time? It might be that your current CPAP settings are no longer adequately treating your sleep apnea -- or you might need to use (more) oxygen at night to help you sleep better and wake up more resting. But don't make any changes on your own. First speak to your doctor to see if having a repeat sleep study might be helpful to optimize your treatment.

      All the best,

      Dave Lederer

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  8. How is the study coming along?

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    1. The National Institutes of Health has reviewed our grant application twice and both times it did not receive funding. Will be submitting the grant again soon.

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  9. Can the use of a CPAP cause damage to the lungs? I use a full-face mask and it works great...I sleep like a baby. I do have a humidifier on my machine. I do have a cough early in the morning, but it is only off and one during the day...not really noticeable.

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    1. I am not aware of any evidence that CPAP can damage the lungs as long as it is used as prescribed by a healthcare provider. It is important that the humidifier be maintained per the manufacturer's recommendations. Mold buildup in the humidifier could be harmful.

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    2. I'm also concerned about whether PF may be secondary to or made worse by the CPAP treatment rather than the OSA. One of the theoretical mechanisms of OSA injury to pneumatocytes is pressure-related stretching. Wouldn't CPAP also cause stretching-related pneumatocyte injury? MikeTX who commented above, was being treated with CPAP after being diagnosed with OSA four years prior to being diagnosed with PF. While it's possible that the CPAP was not at optimal settings, another concern would be that the CPAP may have contributed to the development of PF.

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    3. That's a great thought, and I guess the messages are (1) we don't really know the effect of CPAP treatment in folks with PF, and (2) it's time to do high-quality research that will help us understand if CPAP treatment is helpful (or not) for PF. Thanks for sharing your comments.

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  11. Hi!

    Have been on a CPAP for 20 years. I also have GERD. Was diagnosed with IPF at the Seattle UW Medical Center three years ago. I take no medications for any of these. At my Internist's suggestion I started sleeping with an elevated head. We have a bed that permits this. Shortly thereafter bought reclining sofa for our TV room. Have had no GERD and my IPF oxygen readings run between 95 and 97. It drops to 90-91 when I walk very fast for an extended period with my Standard Poodles off leash.

    I have no idea what is going on with the IPF. Am 71 and retired this year. Have a sense that the GERD while sleeping was a major contributing factor to my IPF outbreak. Hope I continue to be an outlier.

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