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- Title
Obstructive Sleep Apnea and Subclinical Interstitial Lung Disease in the Multi-Ethnic Study of Atherosclerosis (MESA).
- Authors
Kim, John S.; Podolanczuk, Anna J.; Borker, Priya; Kawut, Steven M.; Raghu, Ganesh; Kaufman, Joel D.; Stukovsky, Karen D. Hinckley; Hoffman, Eric A.; Barr, R. Graham; Gottlieb, Daniel J.; Redline, Susan S.; Lederer, David J.
- Abstract
<bold>Rationale: </bold>Obstructive sleep apnea (OSA) has been postulated to contribute to idiopathic pulmonary fibrosis by promoting alveolar epithelial injury via tractional forces and intermittent hypoxia.<bold>Objectives: </bold>To determine whether OSA is associated with subclinical interstitial lung disease (ILD) and with biomarkers of alveolar epithelial injury and remodeling.<bold>Methods: </bold>We performed cross-sectional analyses of 1,690 community-dwelling adults who underwent 15-channel in-home polysomnography and thoracic computed tomographic imaging in the Multi-Ethnic Study of Atherosclerosis. We measured the obstructive apnea-hypopnea index (oAHI) by polysomnography and high-attenuation areas (HAAs) and interstitial lung abnormalities (ILAs) by computed tomography. Serum matrix metalloproteinase-7 (MMP-7) and surfactant protein-A (SP-A) were measured by ELISA in 99 participants. We used generalized linear models to adjust for potential confounders.<bold>Results: </bold>The mean age was 68 years, and the mean forced vital capacity was 97% predicted. The median oAHI was 8.4 events/h, and 32% had an oAHI greater than 15. After adjusting for demographics, smoking, and center, an oAHI greater than 15 was associated with a 4.0% HAA increment (95% confidence interval [CI], 1.4-6.8%; P = 0.003) and 35% increased odds of ILA (95% CI, 13-61%; P = 0.001). However, there was evidence that these associations varied by body mass index (BMI) (P for interaction = 0.08 and 0.04, respectively). Among those with a BMI less than 25 kg/m2, an oAHI greater than 15 was associated with a 6.1% HAA increment (95% CI, 0.5-12%; P = 0.03) and 2.3-fold increased odds of ILA (95% CI, 1.3-4.1; P = 0.005). Among those with a BMI greater than 30 kg/m2, an oAHI greater than 15 was associated with 1.8-fold greater odds of ILA (95% CI, 1.1-2.9; P = 0.01) but was not associated with HAA. There were no meaningful associations detected among those with a BMI of 25-30 kg/m2. Greater oAHI was associated higher serum SP-A and MMP-7 levels, particularly among those with a BMI less than 25 kg/m2.<bold>Conclusions: </bold>Moderate to severe OSA is associated with subclinical ILD and with evidence of alveolar epithelial injury and extracellular matrix remodeling in community-dwelling adults, an association that is strongest among normal-weight individuals. These findings support the hypothesis that OSA might contribute to early ILD.
- Subjects
UNITED States; COMPUTED tomography; INTERSTITIAL lung diseases; LONGITUDINAL method; PROTEOLYTIC enzymes; PULMONARY surfactant; REGRESSION analysis; RESEARCH funding; SLEEP apnea syndromes; POLYSOMNOGRAPHY; BODY mass index; CROSS-sectional method; SEVERITY of illness index; DISEASE complications
- Publication
Annals of the American Thoracic Society, 2017, Vol 14, Issue 12, p1786
- ISSN
2329-6933
- Publication type
journal article
- DOI
10.1513/AnnalsATS.201701-091OC