PURPOSE: Sarcoidosis may be associated with nocturnal desaturation, which could confound obstructive sleep apnea (OSA)-associated nocturnal desaturation. In addition, the evaluation and management of daytime fatigue, which may be multi-factorial, is an important part of sarcoidosis care. After controlling for the apnea-hypopnea index (AHI), we compare severity of nocturnal desaturation in subjects with sarcoidosis and OSA to controls with OSA alone. We also correlate daytime fatigue with severity of OSA, sleep efficiency, and depression in patients with co-existing sarcoidosis and with OSA alone.
METHODS: We reviewed the indices of positive sleep studies in 10 subjects with sarcoidosis, and in 10 controls matched to age, gender and AHI. Time below 90% saturation and lowest oxygen saturation determined severity of nocturnal desaturation. Daytime fatigue was assessed by the Epworth Sleepiness Scale. Severity of OSA was assessed by AHI. Depression was assessed by the CES-D depression scale.
RESULTS: Compared to AHI-matched OSA controls, subjects with co-existing sarcoidosis and OSA demonstrated increased severity of nocturnal desaturation. Compared to controls, subjects with sarcoidosis also had increased daytime fatigue, increased depression, and decreased sleep efficiency.
CONCLUSIONS: In our cohort, patients with co-existing sarcoidosis and OSA experienced increased severity of oxygen desaturation, increased fatigue, increased depression and decreased sleep efficiency. Nocturnal desaturation is associated with increased cardiovascular risk, and patients with co-existing disease may be at especially high risk. Supplemental oxygen may be required in addition to positive pressure ventilation to adequately treat nocturnal desaturation. Sleep inefficiency and depression may be important correlates with daytime fatigue, and may be independent of OSA severity.
CLINICAL IMPLICATIONS: Patients with co-existing sarcoidosis and OSA should be aggressively targeted for treatment of OSA and nocturnal desaturation. In those who have excessive or refractory daytime fatigue, assessing for depression and sleep efficiency should complement the use of positive pressure ventilation in the management strategy.
DISCLOSURE: The following authors have nothing to disclose: Karen Patterson, Frank Huang, Babak Mokhlesi, Kyle Hogarth
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