The overlooked impact of sleep-related breathing disorders in patients with interstitial lung disease

Sleep-related breathing disorders (SRBDs) significantly contribute to the quality of life (QoL) and disease progression of interstitial lung disease (ILD), but have not been thoroughly addressed in ILD management. This review aims to summarise the current literature addressing obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and nocturnal hypoxaemia (NH) in patients with ILD and to highlight existing/novel treatment strategies, as untreated SRBDs worsen symptoms such as chronic fatigue, excessive daytime sleepiness (EDS) and dyspnoea, leading to a vicious cycle that reduces functional capacity and psychological well-being. Validation of the possible role of SRBDs in ILD patients and the correlation of the postulated mechanisms with disease progression will open pathways to perform studies with a larger number of subjects to establish the reliability of biomarkers for early diagnosis and sustained benefits from therapeutic interventions. Polysomnography (PSG) combined with validated questionnaires should be implemented for early screening. Clinicians could address these disturbances in a multidimensional way while minimising disease progression and improving clinical outcomes and QoL. More research is needed to define the diagnostic criteria, implement targeted therapies and establish evidence-based recommendations for the management of sleep disorders in patients with ILD.