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3ο Πανελλήνιο Συνέδριο για τις Διαταραχές του Ύπνου και τον μη Επεμβατικό Αερισμό

3ο Πανελλήνιο Συνέδριο για τις Διαταραχές του Ύπνου και τον μη Επεμβατικό Αερισμό Πνευμονική ίνωση και ΣΑΥ 15-16 Απριλίου 2011. Ευφροσύνη Μάναλη ΓΝΝΘΑ «Η Σωτηρία» Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών.

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3ο Πανελλήνιο Συνέδριο για τις Διαταραχές του Ύπνου και τον μη Επεμβατικό Αερισμό

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  1. 3ο Πανελλήνιο Συνέδριο για τις Διαταραχές του Ύπνου και τον μη Επεμβατικό Αερισμό Πνευμονική ίνωση και ΣΑΥ 15-16 Απριλίου 2011 Ευφροσύνη Μάναλη ΓΝΝΘΑ «Η Σωτηρία» Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών

  2. In IPF a combination of inflammatory and fibrotic lung parenchymal damage leads to the defects in gas mechanics and gas exchange which manifest clinically with progressive exertional dyspnea, the most prominent and disabling symptom in these patients

  3. Παρουσίαση ασθενούς με πνευμονική ίνωση και ΣΑΥ • Ασθενής άνδρας 74 ετών πρώην καπνιστής 15py,συνταξιούχος οικοδόμος • Ιστορικό γαστροοισοφαγικής παλινδρόμησης • Δύσπνοια προσπαθείας από μηνών MRC 2και βήχας

  4. Sat=93% (FiO2=0.21), ΑΠ=120/80 mmHg, 77/min • BMI=30.1 • Velcro στις βάσεις αμφοτέρων των πνευμόνων • Πληκτροδακτυλία

  5. MRC=2 • PFTs: FEV1=1950 ml (76%), FVC=2350 ml (69%), FEV1/FVC=83%, TLC=3.84 (61%), DLCOSB=3.2 (41.9%) • 6MWT= 390m, 93%→88%, Borg 0→2 • CPET: VO2peak ml/min/kg=16.2, SpO2 peak=85%

  6. Συνήθης διάμεση πνευμονία-ιδιοπαθής πνευμονική ίνωση (IPF/UIP)

  7. Πνευμονική ίνωση και ΣΑΥ • Κόπωση κατά τη διάρκεια της ημέρας χωρίς υπνηλία • Epworth Sleepiness Scale score=4 • Πολυκαταγραφική μελέτη ύπνου (NPSG)

  8. CPAP

  9. Πνευμονική ίνωση και ΣΑΥ • Εφαρμογή συσκευής CPAP • Έναρξη φαρμακευτικής αγωγής για ΓΟΠ • Αξιολόγηση ανά 3-6 μήνες

  10. BMI did not correlate strongly with AHI (r=0.30, p=0.05)

  11. Προοπτική μελέτη, 50 ασθενείς IPF ( ATS 2000consensus) • Mean age 64.9y, mean BMI 32.3 • OSA σε 44 (88%), ήπιο 10(20%), μέτριο-σοβαρό 34 (68%) • PFT’s no inverse correlation with AHI or severity OSA • No difference in RVSP in pt with and without OSA • OSA noted in pt with normal BMI (5/44pt, 11%) • 30/44 (68%)pt with OSA did not require home O2 therapy • Comorbidities as GERD were common Lancaster LA et al, Chest 2009

  12. Hypopneas >>apneas • ↓ REM, predominance of S2 sleep • Mean AHI for mild OSA pt 10.7 and mean AHI for moderate-severe OSA pt 39 • 16/50 pt required O2 at the time of the study • More apneas-hypopneas during REM sleep in pt with lower AHI • ESS, SA-SDQ, or in combination,not a good screening tool for IPF pt OSA a highly prevalent comorbidity in IPF Pt with IPF be screened for OSA with NPSG Lancaster LA et al, Chest 2009

  13. Mechanismsin IPF: Interdependence between upper airway size in OSA and lung volumes With increased lung volumes, there is an increase in the traction exerted to the trachea by mediastinal structures resulting from negative intrathoracic pressures and diaphragm descent and as a result the upper airway resistance is reduced. Increased airway length has been linked to OSA severity

  14. No significant correlations between Lung volumes and AHI in IPF patients

  15. Mechanisms in IPF: Rapid swallow breathing pattern , ventilatory control instability

  16. Does the abnormal pattern of breathing in patients with interstitial lung disease persist in deep, non-rapid eye movement sleep? Shea SA, Winning AJ, McKenzie E, Guz A. Department of Medicine, Charing Cross and Westminster Medical School, London, United Kingdom. Comparing wakefulness with S4 sleep: in the normal subjects during sleep, f and PtcCO2 were increased (p less than 0.01 and p less than 0.05, respectively), TE was shortened (p less than 0.01), and ventilation (VI) was unchanged. In contrast, in the patients, f decreased (p less than 0.001), TE lengthened (p less than 0.01), VI decreased (p less than 0.05), and the rise in PtcCO2 seen in the normal subjects during sleep did not occur Am Rev Respir Dis 1989; 139(3): 653-658

  17. 23%, 43%, 34%

  18. Nocturnal dry and irritating cough→ awakening →poor compliance to CPAP • Rapid and swallow breathing especially during progression→ discomfort and claustrophobia, O2 necessary • Frequent titrations needed (disease progression) • Impact of corticosteroids on sleep quality and macroarchitecture and on fat deposition (neck • Depression and mood disorders (insomnia) • CPAP impact on GERD and on IPF morbidity and mortality Mermigkis Ch, et al. Sleep Breath 2010

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