Impact of concomitant obstructive sleep apnea on pulmonary involvement and main pulmonary artery diameter in adults with scleroderma

Abstract

Purpose Pulmonary involvement is common in adults with scleroderma. The effect of concomitant obstructive sleep apnea (OSA) on risk for pulmonary hypertension in scleroderma is unknown. An enlarged main pulmonary artery diameter (mPAD) derived from chest computer tomography (CT) is a useful predictor of pulmonary hypertension. We addressed the effect of OSA on pulmonary involvement and enlarged mPAD in adults with scleroderma. Methods All participants underwent pulmonary function testing, carbon monoxide diffusion capacity, chest CT, and overnight sleep recording with home sleep apnea testing. OSA diagnosis was based on an apnea-hypopnea index (AHI) ≥ 15/h. Oxygen desaturation index (ODI) was also recorded. Scleroderma involvement of the lungs was defined as the Warrick score ≥ 7 based on the CT findings. Enlarged mPAD was defined as an mPAD ≥ 29 mm in men and ≥ 27 mm in women. Results After exclusions, 62 patients (58 women) were included. OSA was found among 20 (32%), 17/42 (38%) in the limited cutaneous type, and 3/20 (15%) in the diffuse cutaneous type (p = 0.08). Scleroderma involvement of the lungs was observed in 40 participants (65% in OSA vs 64% in no-OSA; n.s.). Enlarged mPAD was measured in 16 participants, 10 of 20 (50%) in the OSA group and 6 of 17 (14%) in the no-OSA group (p = 0.003). OSA was associated with enlarged mPAD (odds ratio 4.7, 95% confidence interval 1.1-20.9; p = 0.042) independent of age, body mass index, and pulmonary involvement. There was a linear relationship between mPAD and AHI (r = 0.37; p = 0.003) as well as ODI (r = 0.41; p < 0.001). Conclusions In this cohort, OSA was associated with risk for pulmonary hypertension independent of pulmonary involvement. These findings suggest that assessing the effect of therapy for concomitant OSA in patients with scleroderma is warranted. Trial registration NCT 02740569

Sleep disorders and other medical and socio-demographic factors in systemic scleroderma

“… 15 Obstructive sleep apnea is associated with an increased risk of pulmonary hypertension regardless of the presence of interstitial lung disease, so detection and treatment of sleep apnea in SSc patients is an important measure to prevent or postpone pulmonary hypertension and help to decrease morbidity and mortality in this group. 19 SSc has been described to be linked to lung complications including ILD, pulmonary hypertension, restrictive-ventilatory limitation and fibrosis associated with anatomic changes in the upper airways, 5 affecting sleep quality and sleep breathing movements. In clinical studies, it is also believed that SSc patients with polysomnography findings are at increased risk of sleep disorders.…”

Clinical features of pulmonary arterial hypertension associated with systemic sclerosis

“…These patients with significant ILD belong to WSPH Group 3 (PH diseases due to lung diseases and/or hypoxia). The presence of comorbid obstructive sleep apnea among patients with SSc ranges up to 50% and must be evaluated as this can contribute to changes seen in diagnostic modalities (46)(47)(48)(49). There are also increased rates of thromboembolism which can lead to the development of chronic thromboembolic pulmonary hypertension (Group 4).…”

Esophagus Dilation and Quality of Life in Adults with Scleroderma and Concomitant Obstructive Sleep Apnea

“…Scleroderma involvement of the lungs was shown in 40 out of 62 patients, and enlarged mean pulmonary artery diameter was present in 16 participants. Additionally, a significant correlation was identified between mean pulmonary artery diameter and OSA severity indices, namely the apnea-hypopnea index (AHI) and the oxygen desaturation index (ODI) [11]. It has been suggested that fibrosis associated with scleroderma may exacerbate OSA symptoms by affecting lung and airway function [12].…”