Review article: Obstructive sleep apnea in patients with interstitial lung diseases : links to pulmonary hypertension

Abstract

OSA is a common but frequently underrecognized comorbidity in patients with ILDs, particularly IPF, with prevalence estimates ranging from 22% to 90%. The coexistence of OSA in ILD patients is associated with worsened quality of life, accelerated clinical decline, and increased risk of cardiovascular complications and IPF. Pathophysiologically, reduced lung volumes and traction forces in ILD may promote upper airway collapsibility, especially during REM sleep, while intermittent hypoxia from OSA contributes to systemic inflammation, oxidative stress, and vascular remodeling. Pulmonary hypertension in ILD results from a complex interplay of hypoxia, endothelial dysfunction, and fibrotic processes, further compounding morbidity. CPAP therapy remains the gold standard treatment for moderate-to-severe OSA and has demonstrated beneficial effects on sleep quality, daytime functioning, pulmonary hemodynamics, and potentially on survival in ILD patients with OSA. This review highlights the epidemiology, pathophysiology, clinical impact, and therapeutic implications of OSA in ILD—with or without PH—and emphasizes the importance of early diagnosis and CPAP adherence in improving patient-centered outcomes.