Abstract
STUDY OBJECTIVE: Current literature suggests that obstructive sleep apnea (OSA) occurs in 59–88% of patients with idiopathic pulmonary fibrosis (IPF), with studies proposing that intermittent hypoxemia and elevated levels of inflammatory cytokines from OSA may exacerbate fibrosis progression and worsen hypoxemia, resulting in higher morbidity and mortality. This study seeks to further characterize the association between OSA and IPF progression and its impact on hospitalization and mortality. METHODS: De-identified administrative claims data from the OptumLabs Data Warehouse (OLDW) were obtained from January 2016 through June 2024. Patients with OSA and IPF were identified using ICD-10 codes. A final 1:1 propensity score-matched cohort was constructed to balance confounding factors. Primary outcomes were respiratory-related hospitalizations and all-cause mortality between the groups. Secondary analyses explored factors that were associated with increased hospitalization or mortality. RESULTS: Of 21,469 patients with IPF, 31% had concomitant OSA. Overall, 26% of the patients in the IPF only group and 33% in the IPF + OSA group were treated with an antifibrotic. In addition, 36% of the patients in the IPF group and 46% in the IPF + OSA group received supplemental oxygen. Of the patients with OSA, 34% were treated with CPAP. After propensity score matching, 46% mortality was noted in the IPF group compared to 38% in the IPF + OSA group (p < 0.001) with higher mortality and hospitalizations in patients not on CPAP. There was no difference in respiratory-related hospitalizations between the two groups. CONCLUSION: This study highlights a substantial overlap of OSA in IPF patients and suggests potential survival benefits for those with comorbid OSA. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s44470-026-00054-2.