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

Abstract

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. 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

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

“…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]. The systemic inflammation and fibrotic processes characteristic of SSc may predispose patients to both esophageal dilation and OSA.…”