Draft

228  OSA And Sarcoidosis Lit Review

228.1 Summary

  • OSA and Sarcoidosis
  • (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 169-178) Mari
  • https://doi.org/10.1016/j.rmed.2018.03.021
  • Lal C, Medarov BI, Judson MA. Interrelationship between sleep disordered breathing and sarcoidosis. Chest. 2015;148(4):1105–1114. doi:10.1378/chest.15–0584
    1. Bingol Z, Pihtili A, Gulbaran Z, Kiyan E. Relationship between parenchymalinvolvement and obstructive sleep apnea in subjects withsarcoidosis. Clin Respir J. 2015;9(1):14–21. doi:10.1111/crj.12098
  • Respiration 2017;94:186-197https://doi.org/10.1159/000477352
  • https://link.springer.com/article/10.1007/s11325-021-02513-x
    1. Turner GA, Lower EE, Corser BC, Gunther KL, Baughman RP.Sleep apnea in sarcoidosis. Sarcoidosis, Vasc Diffus lung Dis Off JWASOG. 1997;14(1):61–64. http://www.ncbi.nlm.nih.gov/pubmed/9186990.
  • SARCOIDOSAS study; Italy. Sarcoidosis clinic, dx by ATS criteria.
  • 122 surveys, 84 responded, 68 included.
  • 8 AHI < 5; 25 AHI 5-15; 35 AHI > 15; 35 treated, 18 lost or declined. 20 treated for 3 months then reassessed. 50% mod-severe OSA
  • Elevated fatigue (extreme in ¼). Male gender, BMI, and Higher Scadding stage associated with increase risk. Scadding stage (lung parenchymal involvement also correlates with severity of OSA); fatigue wasn’t.

228.2 Slide outline

228.2.1 Slide 1

  • OSA and Sarcoidosis ### Slide 2
  • (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 169-178) Mari
  • SARCOIDOSAS study; Italy. Sarcoidosis clinic, dx by ATS criteria.
  • 122 surveys, 84 responded, 68 included.
  • 8 AHI < 5; 25 AHI 5-15; 35 AHI > 15; 35 treated, 18 lost or declined. 20 treated for 3 months then reassessed. 50% mod-severe OSA
  • Elevated fatigue (extreme in ¼). Male gender, BMI, and Higher Scadding stage associated with increase risk. Scadding stage (lung parenchymal involvement also correlates with severity of OSA); fatigue wasn’t.
  • Implication: fatigue is common in sarcoidosis, but is not entirely explained by OSA.
  • Similarly, ESS can be caused by sarcoidosis outside of OSA?
  • AHI didn’t predict baseline symptoms well.
  • CPAP improved symptoms (though minority had elevated ESS at baseline). Single arm. High exclusion rate.
  • Both fatigue and ESS improved – however, with 1 group it’s not possible to know how much this is regression to the mean. ### Slide 3
  • https://doi.org/10.1016/j.rmed.2018.03.021
  • Prospective, longitudinal. Sarcoidosis Jan 2010 – Dec 2015 at UCSF; N84 vs 30 controls.
  • High rate (the majority) of sleep complaints (vs few in matched controls) and sleep disordered breathing - not associated with scadding score of PFTs
  • No association with prednisone
  • No routine screening for OSA ### Slide 4
  • Lal C, Medarov BI, Judson MA. Interrelationship between sleep disordered breathing and sarcoidosis. Chest. 2015;148(4):1105–1114. doi:10.1378/chest.15–0584
  • epidemiology: propose that sarcoid neuropathy, obesity due to steroids, upper airway resistance from airway involvement could contribute.
  • In addition, sarcoidosis of the upper respiratory tract (SURT) 8 may result in an increase in upper airways resistance, leading to OSA or related SDB syndromes. 9 (lupus pernio may be associated with this)
  • Fatigue present in 60% of patients with OSA (15), also in 60%ish patients with sarcoidosis (16). Vs EDS (can be caused by sarcoidosis – citation 6)
  • Sarcoidosis can cause pulmonary hypertension, and thus additive effects on the pulmonary vasculature are suspected and lead providers to treat even mild cases to avoid the risk. [ cite this article] PH occurs in 5-20% of sarcoidosis population (more if severe).
  • Not known if the inflammation from OSA influences sarcoid disease activity [cite this article] ### Slide 5
    1. Bingol Z, Pihtili A, Gulbaran Z, Kiyan E. Relationship between parenchymalinvolvement and obstructive sleep apnea in subjects withsarcoidosis. Clin Respir J. 2015;9(1):14–21. doi:10.1111/crj.12098
  • higher Ahi if lung involvement.
  • 29 patients with sarcoidosis, 15 w lung involve vs 14 w/o. OSA prevalence 51.7%, more AHI and lower SaO2 in parenchymal group.
  • How selected? ### Slide 6
  • Respiration 2017;94:186-197https://doi.org/10.1159/000477352
  • Germany, 2009 – survey distributed to members a patient group
  • 1197 sarcoidosis patients: Sleepiness (ESS), Fatigue (FAS)
  • Severe Fatigue 16%; Severe sleepiness 16%
  • EDS: OSA (OR 2.46), dyspnea, and multiorgan involvement
  • Fatigue: depression, anxiety, muscle pain ### Slide 7
  • https://link.springer.com/article/10.1007/s11325-021-02513-x
  • Consecutive patients tested; 70% had sarcoidosis.
  • Higher in treated and treatment naïve patients; also more common in worse disease patients ### Slide 8
    1. Turner GA, Lower EE, Corser BC, Gunther KL, Baughman RP.Sleep apnea in sarcoidosis. Sarcoidosis, Vasc Diffus lung Dis Off JWASOG. 1997;14(1):61–64. http://www.ncbi.nlm.nih.gov/pubmed/9186990.
  • 83 patients with sarcoidosis, 91 control. 17% vs 3 % OSA.

228.3 Learning objectives

  • OSA and Sarcoidosis
  • (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 169-178) Mari
  • https://doi.org/10.1016/j.rmed.2018.03.021
  • Lal C, Medarov BI, Judson MA. Interrelationship between sleep disordered breathing and sarcoidosis. Chest. 2015;148(4):1105–1114. doi:10.1378/chest.15–0584
    1. Bingol Z, Pihtili A, Gulbaran Z, Kiyan E. Relationship between parenchymalinvolvement and obstructive sleep apnea in subjects withsarcoidosis. Clin Respir J. 2015;9(1):14–21. doi:10.1111/crj.12098

228.4 Bottom line / summary

  • OSA and Sarcoidosis
  • (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 169-178) Mari
  • https://doi.org/10.1016/j.rmed.2018.03.021
  • Lal C, Medarov BI, Judson MA. Interrelationship between sleep disordered breathing and sarcoidosis. Chest. 2015;148(4):1105–1114. doi:10.1378/chest.15–0584
    1. Bingol Z, Pihtili A, Gulbaran Z, Kiyan E. Relationship between parenchymalinvolvement and obstructive sleep apnea in subjects withsarcoidosis. Clin Respir J. 2015;9(1):14–21. doi:10.1111/crj.12098

228.5 Approach

  1. TODO: Outline the initial assessment or decision point.
  2. TODO: Outline the next diagnostic or management step.
  3. TODO: Outline follow-up or escalation criteria.

228.6 Red flags / when to escalate

  • TODO: List red flags that require urgent escalation.

228.7 Common pitfalls

  • TODO: Capture common errors or missed steps.

228.8 References

TODO: Add landmark references or guideline citations.

228.9 Slides and assets

228.10 Source materials