Therapy » Chronic night hypoxemia in patients with fibrotic interstitial lung diseases

Chronic night hypoxemia in patients with fibrotic interstitial lung diseases

DOI: https://dx.doi.org/10.18565/therapy.2024.6.36-45

Obukhova A.A., Markov N.V., Zinchenko A.V., Rabik Yu.D., Zaripova Z.A., Skvortsova R.D., Kulikov A.N.
1) Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia; 2) Saint Petersburg State Pediatric Medical University of the Ministry of Healthcare of Russia; 3) Sheba Medical Center, Ramat Gan, Israel

Abstract. Chronic night hypoxemia (CNH) is a common complication in patients with fibrotic interstitial lung diseases (FILD), affecting quality of life and prognosis. Its development may be arised due to the disorders in external respiration apparatus functioning. In this regard, FILD patients need to undergo a comprehensive assessment of their functional status for the purpose of early diagnosis and timely treatment of CNH.
The aim: to assess the dependence of the presence and severity of night hypoxemia on the functional status of FILD patients and to identify possible predictors of the presence of CNH.
Material and methods. The results of studies of 68 patients with FILD are presented. Assessment of the patients’ functional status included such methodics as a complex study of pulmonary function, estimation of acid-base status and arterial blood gases, echocardiography, overnight computer pulse oximetry, and cardiorespiratory stress testing (CRT).
Results. The incidence of CNH in 68 patients having FILD was 25%. Average saturation level in CNH patients directly correlated with the diffusion lung capacity (p = 0.015). Signs of CNH were more often observed in patients with daytime hypoxemia (p < 0.001). During exercise CRT, patients with CNH showed reduced values of VO2 peak, VO2 at the anaerobic threshold (AT), VE/VCO2, and respiratory reserve values. Factors predicting the presence of CNH with high sensitivity and specificity were a decrease in arterial blood pO2 less than 83 mm Hg (p = 0.001) and VO2 at AT less than 29% of normal value (p = 0.009).
Conclusion. The degree of severity of hypoxemia during sleep may be correlated with disturbances in external respiration apparatus functioning, which must be identified during a comprehensive study, including the same through stress testings. The important predictors of CNH in FILD patients are a decrease in arterial blood pO2 during the day time and decrease of oxygen consumption when reaching AT during exercise.

Keywords: cardiorespiratory stress testing, chronic night hypoxemia, fibrotic interstitial lung diseases

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About the Autors

Anna A. Obukhova, MD, postgraduate student of the Department of functional diagnostics, doctor of functional diagnostics of the Department of functional diagnostics, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia, assistant at the Department of general medical practice, Saint Petersburg State Pediatric Medical University of the Ministry of Healthcare of Russia. Address: 194100, Saint Petersburg, 2 Litovskaya St.
E-mail: Obukhova_ann@mail.ru
ORCID: https://orcid.org/0000-0003-4818-9255
Nikita V. Markov, MD, pulmonologist at the Department of respiratory therapy of the clinic of the Research Institute of Interstitial and Orphan Lung Diseases, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo St.
E-mail: markovnik1195@gmail.com
ORCID: https://orcid.org/0000-0002-6992-0169
Arina V. Zinchenko, MD, head of the Department of respiratory therapy, pulmonologist at the clinic of the Research Institute of Interstitial and Orphan Lung Diseases, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo St.
E-mail: arina.zinchenko@gmail.com
ORCID: https://orcid.org/0000-0001-5087-0192
Yulia D. Rabik, MD, PhD (Medicine), assistant at the Department of functional diagnostics, head of the Department of functional diagnostics No. 2, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo St.
E-mail: rabjul@yandex.ru
ORCID: https://orcid.org/0000-0002-7114-8489
Zulfiya A. Zaripova, MD, PhD (Medicine), associate professor of the Department of anesthesiology and reanimatology, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo St.
E-mail: realzulya@mail.ru
ORCID: https://orcid.org/0000-0002-2224-7536
Ruth D. Skvortsova, vascular surgeon at Sheba Medical Center in Ramat Gan. Address: Israel, Ganei Tikva, 27/19 Derech Hatikva St.
Е-mail: dr.ruf12@gmail.com
ORCID: https://orcid.org/0000-0002-9523-2749
Alexander N. Kulikov, MD, Dr. Sci. (Medicine), professor, head of the Department of functional diagnostics, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo St.
E-mail: ankulikov2005@yandex.ru
ORCID: https://orcid.org/0000-0002-4544-2967

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