Department of Allergology and Immunology, Süreyyapasa Chest Diseases and Chest Surgery Training & Research Hospital, Istanbul, Turkey.
Department of Pulmonary Medicine, Marmara University, School Medicine, Istanbul, Turkey.
Sleep Breath. 2021 Mar;25(1):135-143. doi: 10.1007/s11325-020-02059-4. Epub 2020 Apr 13.
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.
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.
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).
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.
NCT02740569.
硬皮病患者常伴有肺部受累。阻塞性睡眠呼吸暂停（OSA）对硬皮病患者肺动脉高压风险的影响尚不清楚。胸部计算机断层扫描（CT）得出的主肺动脉直径增大（mPAD）是肺动脉高压的有用预测指标。我们旨在研究 OSA 对硬皮病患者的肺部受累和 mPAD 增大的影响。
所有参与者均接受肺功能检查、一氧化碳弥散能力检查、胸部 CT 检查和家庭睡眠呼吸暂停检测的夜间睡眠记录。OSA 的诊断基于呼吸暂停低通气指数（AHI）≥15/h。还记录了氧减指数（ODI）。根据 CT 结果，将硬皮病肺部受累定义为 Warrick 评分≥7。mPAD 增大定义为男性 mPAD≥29mm，女性 mPAD≥27mm。
排除后，共纳入 62 名患者（58 名女性）。20 名（32%）患者存在 OSA，局限性硬皮病患者中 17/42（38%）存在 OSA，弥漫性硬皮病患者中 3/20（15%）存在 OSA（p=0.08）。40 名参与者（OSA 组 65%，无 OSA 组 64%）存在硬皮病肺部受累（n.s.）。16 名参与者测量了 mPAD，OSA 组 10 名（50%），无 OSA 组 6 名（14%）（p=0.003）。OSA 与 mPAD 增大相关（比值比 4.7，95%置信区间 1.1-20.9；p=0.042），与年龄、体重指数和肺部受累无关。mPAD 与 AHI（r=0.37；p=0.003）和 ODI（r=0.41；p<0.001）呈线性关系。
在本队列中，OSA 与肺动脉高压风险相关，与肺部受累无关。这些发现表明，有必要评估硬皮病患者合并 OSA 治疗的效果。
NCT02740569。
