Individuals With Scleroderma May Have Increased Risk of Sleep-Disordered Breathing

Abstract

Study Objectives: Scleroderma is associated with abnormal skin thickening, interstitial lung disease, pulmonary hypertension, and abnormalities of the upper airway. These changes can cause cardiopulmonary complications, potentially including sleep-disordered breathing. The objective of this study is to examine the risk of sleep-disordered breathing in patients with scleroderma. Methods: We retrospectively identified patients with documented scleroderma. We abstracted data from their electronic health records, including findings from antibody tests, serial pulmonary function tests, transthoracic echocardiography, high-resolution computed tomography, and overnight forehead oximetry. Results: We identified 171 patients with scleroderma. Mean age at the time of initial consult was 56.5 years (range, 18-96 years), and 150 (86.7%) were women. Scleroderma was categorized as limited disease for 108 (62.4%), diffuse disease for 59 (34.1%), and mixed connective tissue disease for 6 (3.5%). Fifty-four patients (31.2%) had abnormal overnight forehead oximetry results, defined as an oxygen desaturation index greater than 5 or a baseline mean arterial oxygen saturation level less than 90%. Conclusions: Cardiopulmonary complications are common in patients with scleroderma, one of which may be sleep-disordered breathing. In our cohort, approximately one-third of individuals with scleroderma had evidence of sleep-disordered breathing. Moreover, the rate of sleep-disordered breathing in our population of scleroderma patients was twice the rate of pulmonary hypertension and was approximately the same as the rate of interstitial lung disease. Future prospective studies are needed to further assess the role of sleep-disordered breathing in scleroderma clinical outcomes.

Pulmonary artery dilatation and obstructive sleep apnea

“…6 There is also a suggestion that obstructive sleep apnea is associated with enlargement of the main pulmonary artery. 7,8 The current study, 1 although retrospective, again highlights that in patients with SDB, repetitive nocturnal hypoxemia, and large intrathoracic negative pressure swings attributable to recurrent upper airway obstruction could affect pulmonary hemodynamics and may lead to pulmonary artery dilatation, although we agree that this concept needs to be studied further.…”

“…We read with great interest the article by Nokes et al 1 reporting a high incidence of sleep-disordered breathing [SDB] in patients with scleroderma as evaluated by overnight pulse oximetry. It is interesting to note that the authors report in their study that in scleroderma patients, the only predictive variables for abnormal overnight oximetry [defined as [ODI >5/h or a mean oxygen saturation < 90%] were advancing age and pulmonary artery diameter >3.0 cm.…”

An Update on Systemic Sclerosis and its Perioperative Management

“…Several aspects of postoperative monitoring should be considered after surgical intervention. SSc patients may be at risk for postoperative sleep-disordered breathing has been reported with 31.2% of patients having abnormal pulse oximetry readings on sleep studies [ 81 ]. This suggests that SSc patients may benefit from close postoperative ventilatory monitoring.…”

Scleroderma and obstructive sleep apnea: a consideration of immunological aspects and the role of fibrosis

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Sleep disorders are known to be related to autoimmune diseases due to the inflammatory and immunological imbalance induced by or aggravating poor sleep [1]. In this context, we are writing to discuss a relationship that needs to be more clearly understood, that between obstructive sleep apnea (OSA)-a widely prevalent sleep breathing disorder [2]and scleroderma-an autoimmune disease that can affect breathing through a number of mechanisms, including lung fibrosis.

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“…We highlight pathological and immunological features that both diseases might have in common, and which warrant further clarification.Scleroderma is an autoimmune disease that affects collagen and can present as a restricted dermatological condition, characterized by thickening of the skin, or as a systemic syndrome that evolves with a more severe clinical outcome. This systemic condition can be accompanied by significant collagen fibrosis that affects several organs beyond the skin, such as the esophagus, heart, and lungs, and carries with it great potential for health complications [1,3], including impaired breathing that can worsen a pre-existing OSA.Autoimmune and inflammatory diseases may lead to the impairment of sleep quality and a decrease in quality of life as a whole. In the case of scleroderma, it can cause lung complications, which can be manifested by interstitial lung disease and pulmonary hypertension, as well as restrictive-ventilatory limitation and anatomic changes in the upper airways due to…”