Gastroesophageal Reflux, Sleep-Disordered Breathing, and Outcomes in Patients With Idiopathic Pulmonary Fibrosis

Gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) may negatively impact idiopathic pulmonary fibrosis (IPF), but data on their concurrent contributions are lacking. We aimed to test the contributions of GERD and sleep-disordered breathing (SDB) to IPF outcomes.

We performed a cross-sectional, exploratory study on subjects with IPF. Clinically established GERD diagnosis, questionnaires (Nocturnal GERD Symptom Severity and Impact Questionnaire [N-GSSIQ], the NIH Patient-Reported Outcomes Measurement Information System [PROMIS] sleep impairment and fatigue scales, and Short Form-36 [SF-36]), full pulmonary function tests (PFT), six-minute walk test (6MWT), and nocturnal polysomnography (PSG) were obtained.

Among n = 24 subjects, 17 (71%) had clinically diagnosed GERD. N-GSSIQ scores indicated a nocturnal burden, which was adversely related to sleep impairment (p = 0.010) and daytime fatigue (p = 0.001), tiredness (p = 0.026) and SF-36 social functioning (p = 0.005), energy/fatigue (p = 0.015), pain (p = 0.030), and health change in the prior year (p = 0.035). From PSG, GERD correlated with worse sleep architecture (GERD diagnosis, all p < 0.05) and periodic leg movements index (PLMI) (N-GSSIQ, p = 0.02). GERD was not associated with pulmonary or exercise physiology. Overall, apnea-hypopnea index (AHI) was (median [25% quartile, 75% quartile]) 18.2 (8.1, 27.8)/h, and 19 (79%) subjects had OSA (AHI ≥ 5/h), with most (15/19 [79%]) having moderate or severe disease. SDB measures adversely related to gas exchange and distance walked (all p < 0.05).

A nocturnal burden of GERD was detected and related to sleep disruption, including PLMs, and to daytime complaints. SDB/OSA, of a severity known to have significant health consequences, was common; it was adversely related to pulmonary diffusion and exercise capacity. These findings call for comprehensive, early evaluation of GERD and OSA for improved IPF outcomes.