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Original research
Nocturnal hypoxaemia in interstitial lung disease: a systematic review
  1. Yet Hong Khor1,2,3,
  2. Yvonne Ng4,
  3. Duncan Sweeney1,2,
  4. Christopher J Ryerson5,6
  1. 1 Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
  2. 2 Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
  3. 3 Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
  5. 5 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  6. 6 Centre for Heart Lung Innovation, Providence Health Care, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Yet Hong Khor, Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; yethong.khor{at}


Background Patients with interstitial lung disease (ILD) are at risk of developing nocturnal hypoxaemia due to ventilatory restriction and impaired gas exchange that worsen with supine posture and reduced ventilatory drive during sleep. This systematic review synthesised literature on the diagnostic evaluation, epidemiology, associations, management and prognosis of nocturnal hypoxaemia in ILD.

Methods Ovid MEDLINE, Embase and CENTRAL databases were searched for eligible studies. Meta-analyses with subgroup analyses were conducted, where possible.

Results Fifty-three studies were included (total participant number=2590). The most common definition for clinically significant nocturnal hypoxaemia was ≥10% of total sleep time with oxyhaemoglobin saturation <90%, with pooled prevalence of 37%. There were no significant differences in pooled prevalence according to ILD subtype and comorbid obstructive sleep apnoea status. Study heterogeneity precluded meta-analysis of associations and prognosis. Diffusing capacity for carbon monoxide (DLCO) and echocardiographic features for pulmonary hypertension were consistently associated with nocturnal hypoxaemia. There were inconsistent associations between nocturnal hypoxaemia with ILD subtype and severity. Multivariable analyses in most studies demonstrated significant associations of nocturnal hypoxaemia with survival. Two small short-term intervention studies demonstrated that supplemental oxygen of 1–3 L/min corrected nocturnal hypoxaemia, with improved heart rate control during in-laboratory observation and increased serum antioxidant levels after 1 month of therapy.

Conclusion Nocturnal hypoxaemia is common, associated with DLCO impairment and markers suggestive of pulmonary hypertension, and a potential prognostic factor in patients in ILD. There is a need to establish a consensus definition of nocturnal hypoxaemia and evaluate long-term effects of nocturnal supplemental oxygen in ILD.

  • idiopathic pulmonary fibrosis
  • interstitial fibrosis
  • sleep apnoea
  • long term oxygen therapy (LTOT)

Data availability statement

Data are available on reasonable request.

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  • Contributors YHK and CJR were responsible for review conception and development of the review protocol. YHK, YN and DS were responsible for study selection, quality assessment, and data extraction. YHK was responsible for data analysis. YHK and CJR interpreted the data. YHK drafted the manuscript. All authors revised and approved the manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests YHK reports non-financial trial support from Air Liquide Healthcare, outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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