A 58-Year-Old Man With Position-Dependent Nocturnal Dyspnea

Area of Science:

• Pulmonary Medicine
• Sleep Medicine
• Transplant Surgery

Background:

• Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease.
• Lung transplantation is a treatment option for advanced IPF.
• Immunosuppression is required post-transplantation to prevent rejection.

Observation:

• A 58-year-old male, 2 years post-right single-lung transplant for IPF, presented with positional dyspnea and arousals when sleeping on his right side.
• He reported fatigue and unrefreshing sleep, with an Epworth Sleepiness Scale score of 12/24.
• Nocturnal symptoms were position-dependent, specifically when lying on the transplanted lung side.

Findings:

• The patient's symptoms suggest potential airway compression or altered mechanics related to sleeping position after lung transplantation.
• Positional worsening of respiratory symptoms and sleep quality can occur in lung transplant recipients.
• Underlying conditions including coronary artery disease and chronic kidney failure were noted.

Implications:

• This case underscores the importance of evaluating sleep disturbances in lung transplant recipients.
• Positional therapy or further investigation into airway dynamics may be beneficial.
• Further research is needed to understand and manage post-lung transplant sleep-related breathing disorders.