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Sleep and Breathing

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12-11-2021 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

The frequency of obstructive sleep apnea in patients with primary Sjogren’s syndrome

Authors: Emine Karabul, Sermin Borekci, Serdal Ugurlu, Benan Musellim

Published in: Sleep and Breathing | Issue 4/2022

Abstract

Introduction

There is a lack of information about the frequency of obstructive sleep apnea (OSA) in primary Sjogren’s syndrome (pSS). Using all-night polysomnography (PSG), this study aimed to investigate the frequency of OSA in pSS and the factors affecting the frequency of OSA in this condition.

Methods

Consecutive patients with pSS who presented to the Collagen Tissue Diseases follow-up polyclinic of the Department of Chest Diseases between 1 April 2019 and 31 December, 2020, were included in the study. Demographic characteristics, chronic diseases, smoking history in pack-years, anthropometric data, Epworth Sleepiness Scale score, pulmonary function test parameters, current thorax computed tomography findings, and PSG data were recorded. The control group was created by the retrospective screening of patients admitted to the sleep polyclinic and who underwent PSG but did not have pSS.

Results

OSA was detected in 37 (84%) of 44 patients with pSS who underwent PSG. Of 37 patients with OSA, 25 (68%) had moderate or severe OSA. Snoring and witnessed apneas, REM%, snoring index, and maximum apnea and maximum hypopnea duration were statistically significantly lower in the pSS group compared with the control group (p < 0.001, p = 0.003, p = 0.025, p = 0.001, p = 0.028, and p = 0.035, respectively).

Conclusion

The frequency of OSA in patients with pSS was 84%, with a decrease in REM%. Although a correlation between symptoms suggesting OSA and the presence of radiological lung involvement, spirometry, and DLCO values with OSA could not be demonstrated, physicians are recommended to be attentive for the presence of OSA in all patients with pSS and to investigate OSA using PSG.

Ramos-Casals M, Tzioufas AG, Font J (2005) Primary Sjögren’s syndrome: new clinical and therapeutic concepts. Ann Rheum Dis 64:347–354CrossRefPubMed

Bowman SJ, Ibrahim GH, Holmes G et al (2004) Estimating the prevalence among Caucasian women of primary Sjögren’s syndrome in two general practices in Birmingham, UK. Scand J Rheumatol 33:39–43CrossRefPubMed

Karageorgas T, Fragioudaki S, Bezos A et al (2015) Fatigue in primary Sjogren’s Syndrome: clinical, laboratory, psychometric and biological associations. Arthritis Care Res 68:123–131CrossRef

Young T, P. E. Peppard ve D. J. Gottlieb, (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239CrossRefPubMed

Young T, Palta M, Dempsey J et al (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235CrossRefPubMed

Karageorgas T, Fragioudaki S, Nezos A et al (2016) Fatigue in primary Sjögren’s syndrome: clinical, laboratory, psychometric, and biologic associations. Am Coll Rheumatol 68:123–131

Usmani ZA, Hlavac M, Rischmueller M et al (2012) Sleep-disordered breathing in patients with primary Sjögren’s Syndrome: a group controlled study. Sleep Med 13:1066–1070CrossRefPubMed

Jülich M, Budweiser S, Thoden J et al (2019) Sleep apnea in Sjögren’s syndrome potentially influences the EULAR Sjögren’s syndrome patient reported index. Mod Rheumatol 29:563–565CrossRefPubMed

Vitali C, Bombardieri S, Jonsson R et al (2002) Classification criteria for Sjogren’s Syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 61:554–558CrossRefPubMedPubMedCentral

10.

National Institutes of Health (1998) Clinical guidelines on the ıdentification, evaluation, and treatment of overweight and obesity in adults-the evidence report. Obes Res 6(Suppl 2):51S-209S

11.

Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 8:597–619CrossRefPubMedPubMedCentral

12.

Uzer F, Toptal AB, Okur U et al (2018) Comparison of positional and rapid eye movement-dependent sleep apnea syndromes. Ann Thorac Med 13:42–47CrossRefPubMedPubMedCentral

13.

Omobomi O, Quan SF (2018) Positional therapy in the management of positional obstructive sleep apnea-a review of the current literature. Sleep Breath 22:297–304CrossRefPubMed

14.

Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest 103:30–36CrossRefPubMed

15.

Graham BL, Steenbruggen I, Miller MR et al (2019) Standardization of Spirometry 2019 Update, An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 200:e70–e88CrossRefPubMedPubMedCentral

16.

Graham BL, Brusasco V, Burgos F et al (2017) 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J 49:1600016CrossRefPubMed

17.

Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR (2010) Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med 11:441–446CrossRefPubMed

18.

Peppard PE, Young T, Palta M et al (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015CrossRefPubMed

19.

Hoffstein V, Mateika S (1992) Differences in abdominal and neck circumferences in patients with and without obstructive sleep apnoea. Eur Respir J 5:377–381PubMed

20.

Gundogdu S, Borekci S, Atahan E, Musellim B (2021) Increased frequency of obstructive sleep apnea in the patients with systemic sclerosis. Sleep Breath 25:237–242CrossRefPubMed

21.

Wetter DW, Young TB, Bidwell TR et al (1994) Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 154:2219CrossRefPubMed

22.

Hackett KL, Gotts ZM, Ellis J et al (2017) An investigation into the prevalence of sleep disturbances in primary Sjögren’s Syndrome: a systematic review of the literature. Rheumatology (Oxford) 56:570–580

23.

Gudbjörnsson B, Broman JE, Hetta J et al (1993) Sleep disturbances in patients with primary Sjogren’s syndrome. Br J Rheumatol 32:1072–1076CrossRefPubMed

24.

Mermigkis C, Chapman J, Golish J et al (2007) Sleep-related breathing disorders in patients with ıdiopathic pulmonary fibrosis. Lung 185:173–178CrossRefPubMed

25.

Lancaster LH, Mason WR, Parnell JA et al (2009) Obstructive sleep apnea is common in idiopathic pulmonary fibrosis. Chest 136:772–778CrossRefPubMedPubMedCentral

26.

Pihtili A, Bingol Z, Kiyan E et al (2013) Obstructive sleep apnea is common in patients with interstitial lung disease. Sleep Breath 17:1281–1288CrossRefPubMed

27.

Goodchild CE, Treharne GJ, Booth DA, Bowman SJ (2010) Daytime patterning of fatigue and its associations with the previous night’s discomfort and poor sleep among women with primary Sjogren’s Syndrome or rheumatoid arthritis. Musculoskeletal Care 8:107–117CrossRefPubMed

28.

Hilditch CJ, McEvoy RD, George KE et al (2008) Upper airway surface tension but not upper airway collapsibility is elevated in primary Sjögren’s Syndrome. Sleep 31:367–374CrossRefPubMedPubMedCentral

29.

Prado GF, Allen RP, Trevisani VMF et al (2002) Sleep disruption in systemic sclerosis (scleroderma) patients: clinical and polysomnographic findings. Sleep Med 3:341–345CrossRefPubMed

Title: The frequency of obstructive sleep apnea in patients with primary Sjogren’s syndrome
Authors: Emine Karabul
Sermin Borekci
Serdal Ugurlu
Benan Musellim
Publication date: 12-11-2021
Publisher: Springer International Publishing
Keywords: Sleep Apnea
Spirometry
Polysomnography
Snoring
Published in: Sleep and Breathing / Issue 4/2022
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02491-0

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