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Title: Nocturnal hypoxaemia in interstitial lung disease: a systematic review.
Austin Authors: Khor, Yet Hong;Ng, Yvonne;Sweeney, Duncan J ;Ryerson, Christopher J
Affiliation: Centre for Heart Lung Innovation, Providence Health Care, Vancouver, British Columbia, Canada
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Respiratory and Sleep Medicine
Institute for Breathing and Sleep
Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
Issue Date: 29-Apr-2021
Date: 2021-04-29
Publication information: Thorax 2021; 76(12): 1200-1208
Abstract: Patients with interstitial lung disease (ILD) are at risk of developing nocturnal hypoxaemia due to ventilatory restriction and impaired gas exchange that worsen with supine posture and reduced ventilatory drive during sleep. This systematic review synthesised literature on the diagnostic evaluation, epidemiology, associations, management and prognosis of nocturnal hypoxaemia in ILD. Ovid MEDLINE, Embase and CENTRAL databases were searched for eligible studies. Meta-analyses with subgroup analyses were conducted, where possible. Fifty-three studies were included (total participant number=2590). The most common definition for clinically significant nocturnal hypoxaemia was ≥10% of total sleep time with oxyhaemoglobin saturation <90%, with pooled prevalence of 37%. There were no significant differences in pooled prevalence according to ILD subtype and comorbid obstructive sleep apnoea status. Study heterogeneity precluded meta-analysis of associations and prognosis. Diffusing capacity for carbon monoxide (DLCO) and echocardiographic features for pulmonary hypertension were consistently associated with nocturnal hypoxaemia. There were inconsistent associations between nocturnal hypoxaemia with ILD subtype and severity. Multivariable analyses in most studies demonstrated significant associations of nocturnal hypoxaemia with survival. Two small short-term intervention studies demonstrated that supplemental oxygen of 1-3 L/min corrected nocturnal hypoxaemia, with improved heart rate control during in-laboratory observation and increased serum antioxidant levels after 1 month of therapy. Nocturnal hypoxaemia is common, associated with DLCO impairment and markers suggestive of pulmonary hypertension, and a potential prognostic factor in patients in ILD. There is a need to establish a consensus definition of nocturnal hypoxaemia and evaluate long-term effects of nocturnal supplemental oxygen in ILD.
DOI: 10.1136/thoraxjnl-2020-216749
ORCID: 0000-0002-5434-9342
Journal: Thorax
PubMed URL: 33927018
Type: Journal Article
Subjects: idiopathic pulmonary fibrosis
interstitial fibrosis
long term oxygen therapy (LTOT)
sleep apnoea
Appears in Collections:Journal articles

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