Sleep Apnea in Sarcoidosis

Abstract

PURPOSE:The main purpose of this study is to estimate the prevalence of sleep related breathing disorders in patients with sarcoidosis by using Sleep Apnea/Sleep Disorders Questionnaire (SA/SDQ) and Epworth Sleepiness Scale (ESS).METHODS: 70 consecutive patients with diagnosis of biopsy proven sarcoidosis seen at the sarcoid clinic were screened for sleep related breathing disorders using SA/SDQ and ESS. The SA/SDQ consists of 8 questions and 4 other items related to weight, smoking status, age, and body mass index, which are calculated to generate a raw score. Total scores range from 0-60. To suspect sleep apnea, cutoffs of 32 for women and 36 for men were used as a criteria for sleep study referral.RESULTS: 70 patients with sarcoidosis completed the questionnaires. There were 42 females and 28 males with a mean age of 48 ± 10 years. 34% of pateints were African American. Mean duration of diagnosis was 78 months. 60% of patients had 2 or more organs involved. Approximately 2/3rd of patients were actively treated with steroids or other immunosupressive agents (mean prednisone dose was 7 mg/day). 39 patients had positive questionnaires (25 with positive SA/SDQ while 14 with positive ESS). Considering the reported 81% specificity of SA/SDQ for sleep apnea in general population, 39% of patients will most likely have sleep apnae syndrome by polysomnography. CONCLUSION:The prevalence of sleep apnea syndrome in patients with sarcoidosis is significantly high. In this study, we persented our experience with SA/SDQ as a screening instrument for sleep disordered breathing in a sample of patients with sarcoidosis.CLINICAL IMPLICATIONS: Screening tools such as the SA/SDQ are gaining increasing importance because of high prevalence of sleep disordered breathing in chronic diseases and the high cost of polysomnography. Sleep disordered breathing is highly prevalent in our sarcoid population and SA/SDQ may be a useful test in identifying patients at risk for sleep apnea syndrome.

Relationship between parenchymal involvement and obstructive sleep apnea in subjects with sarcoidosis

“…In a preliminary study done by Mughal et al . in 2005, ESS and sleep apnea questionnaires were administered to 70 sarcoidosis patients, and OSA prevalence was found 39% in sarcoidosis patients . However, none of the patients had polysomnography in that study, and diagnosis of OSA was based on Sleep Apnea/Sleep Disorders Questionnaire and ESS score.…”

“…In the literature, there are few studies about sleep‐related breathing disorders in sarcoidosis . The frequency of OSA was found to be high in these studies.…”

“…Additionally, periodic leg movements (PLM) and restless legs syndrome (RLS) were reported as important problems in sarcoidosis . Excluding these studies, presence of OSA in sarcoidosis was reported only in case reports and meeting abstract . Fatigue was found to be associated with OSA in the patients with sarcoidosis because of side effects of the medical treatment (weight gain because of corticosteroid usage) asymptomatic muscle involvement of sarcoidosis, RLS and PLM .…”

Treatment of Sarcoidosis

“…64 In our center, we screened 70 consecutive patients with the Sleep Apnea/Sleep Disorders Questionnaire and ESS. 65 Thirty-nine percent of the patients had screening values suggesting a high likelihood of sleep apnea. 65 A less common cause of obstructive sleep apnea (OSA) in the sarcoidosis population is granulomatous involvement of the upper respiratory tract.…”

“…65 Thirty-nine percent of the patients had screening values suggesting a high likelihood of sleep apnea. 65 A less common cause of obstructive sleep apnea (OSA) in the sarcoidosis population is granulomatous involvement of the upper respiratory tract. 66 Other symptoms that may not respond well to immunosuppressants include dyspnea and pain syndromes.…”