Organmanifestation und subjektive Schlafqualität bei Sarkoidose

Zusammenfassung

Ziel der Studie: Schlafstörungen treten bei Sarkoidosepatienten häufiger als in der Allgemeinbevölkerung auf. In einer großen Gruppe von Sarkoidosepatienten wurde untersucht, welchen Einfluss die Organbeteiligung auf die subjektive Schlafqualität hat.

Methodik: In Zusammenarbeit mit der Deutschen Sarkoidose-Vereinigung konnten 1197 Sarkoidosepatienten mit einem speziell entwickelten Fragebogen, in den auch der Pittsburgh Schlafqualitätsindex (PSQI) integriert war, untersucht werden.

Ergebnisse: 91 % hatten eine Lungenbeteiligung, 65 % eine extrapulmonale Sarkoidose. Bei 61 % waren mindestens 2 Organe involviert. Mit steigender Organbeteiligung verschlechterte sich die subjektive Schlafqualität im PSQI signifikant (p < 0,001), und die Prävalenzen von anamnestisch bekannter Schlaf-Apnoe (p < 0,005) und Restless legs Syndrom (RLS), der Frauenanteil und die Begleiterkrankungen (alle p < 0,001) nahmen zu. Bei Beteiligung von Knochen, Muskeln, Nerven, Nieren oder Herz erreichten ≥ 33 % einen PSQI-Wert > 10.

Schlussfolgerung: Bei Sarkoidosepatienten mit Beteiligung von mindestens 2 Organen sollte eine Evaluation des Schlafverhaltens einschließlich Diagnostik von RLS und Schlaf-Apnoe erfolgen.

Abstract

Background: Sleep disturbances are more common among sarcoidosis patients than in the general population. The influence of organ involvement on the subjective sleep quality was investigated in a large group of sarcoidosis patients.

Methods: In collaboration with the German Sarcoidosis Association, 1197 sarcoidosis patients were examined with a specially developed questionnaire with the Pittsburgh sleep quality index (PSQI) integrated into it.

Results: 91 % had pulmonary involvement, 65 % extra-pulmonary sarcoidosis. In 61 %, two or more organs were involved. Subjective sleep quality in PSQI declined significantly (p < 0.001) with the increase in the number of organs involved; there was a significant increase in the prevalence of known sleep apnea (p < 0.005), restless legs syndrome (RLS), percentage of women and comorbidities (all p < 0.001). In at least 33 % of patients with bone, muscle, nerve, kidney or heart involvement, the PSQI scores were > 10.

Conclusions: In sarcoidosis patients with involvement of at least 2 organs, sleeping behaviour that includes RLS and sleep apnea should be evaluated.

• Literatur

• 1 Scharkoff T. Epidemiologie der Sarkoidose. Pneumologie 1993; 47: 588-592
• 2 Baughman RP, Teirstein AS, Judson MA et al. Case Control Etiologic Study of Sarcoidosis (ACCESS) Research Group. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001; 164: 1885-1889
• 3 Judson MA. Extrapulmonary sarcoidosis. Semin Respir Crit Care Med 2007; 28: 83-101
• 4 Maña J, Marcoval J, Rubio M et al. Granulomatous cutaneous Sarcoidosis: Diagnosis, relationship to systemic disease, prognosis and treatment. Sarcoidosis Vasc Diffuse Lung Dis 2013; 30: 268-281
• 5 Baughman RP, Lower EE, Ingledue R et al. Management of ocular sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2012; 29: 26-33
• 6 Okumus G, Musellim B, Cetinkaya E et al. Extrapulmonary involvement in patients with sarcoidosis in Turkey. Respirology 2011; 16: 446-450
• 7 Valeyre D, Prasse A, Nunes H et al. Sarcoidosis. Lancet 2014; 383: 1155-1167
• 8 Judson MA, Boan AD, Lackland DT. The clinical course of sarcoidosis: Presentation, diagnosis, and treatment in a large white and black cohort in the United States. Sarcoidosis Vasc Diffuse Lung Dis 2012; 29: 119-127
• 9 Deepak AR, Dellaripa PF. Extrapulmonary manifestations of sarcoidosis. Rheum Dis Clin North Am.2013 May 39: 277-297
• 10 Dempsey OJ, Paterson EW, Kerr KM et al. Sarcoidosis. BMJ 2009 339: b3206
• 11 Turner GA, Lower EE, Corser BC et al. Sleep apnea in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 1997; 14: 61-64
• 12 Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea? The Rational Clinical Examination systematic review. JAMA 2013; 310: 731-741
• 13 Verbraeken J, Hoitsma E, Van der Grinten CP et al. Sleep disturbances associated with periodic leg movements in chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2004; 21: 137-146
• 14 Hoitsma E, Marziniak M, Faber CG et al. Small fiber neuropathy in sarcoidosis. Lancet 2002; 359: 2085-2086
• 15 Heij L, Dahan A, Hoitsma E. Sarcoidosis and pain caused by small- fiber neuropathy. Pain Res Treat 2012 2012: 256024
• 16 Bosse-Henck A, Wirtz H, Hinz A. Subjective sleep quality in sarcoidosis. Sleep Med 2015; 16: 570-576
• 17 Ohayon MM, O’Hara R, Vitello MV. Epidemiology of restless legs syndrome: A synthesis of the literature. Sleep Med Rev 2012; 16 : 283-295
• 18 Zeitlhofer J, Schmeiser-Rieder A, Tribl G et al. Sleep and quality of life in the Austrian population. Acta Neurol Scand 2000; 102: 249-257
• 19 Abad VC, Sarinas PS, Guilleminault C. Sleep and rheumatologic disorders. Sleep Med Rev 2008; 12: 211-228
• 20 Taylor DJ, Mallory LJ, Lichstein KL et al. Comorbidity of chronic insomnia with medical problems. Sleep 2007; 30: 213-218
• 21 Budhiraja R, Roth T, Hudgel DW et al. Prevalence and polysomnographic correlates of insomnia comorbid with medical disorders. Sleep 2011; 34: 859-867
• 22 Bestall JC, Paul EA, Garrod R et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999; 54: 581-586
• 23 Buysse DJ, Reynolds CF, Monk TH et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiat Res 1989; 28: 193-213
• 24 Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. Sleep 2006; 29: 85-93
• 25 Wittchen HU, Krause P, Höfler M et al. NISAS-2000 – the „Nationwide Insomnia Screening and Awareness Study. Prevalence and interventions in primary care. Fortschr Med Orig 2001; 119: 9-19
• 26 Li Y, Walters AS, Chiuve SE et al. Prospective study of restless legs syndrome and coronary heart disease among women. Circulation 2012; 126: 1689-1694
• 27 Winter AC, Berger K, Glynn RJ et al. Vascular risk factors, cardiovascular disease, and restless legs syndrome in men. Am J Med 2013; 126: 228-235
• 28 Vgontzas AN, Liao D, Bixler EO et al. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 2009; 32: 491-497
• 29 Lai Y-J, Lin C-L, Lin M-C et al. Population-based cohort study on the increase in the risk for type 2 diabetes mellitus development from nonapnea sleep disorders. Sleep Med 2013; 14: 913-918
• 30 Mai E, Buysse DJ. Insomnia: prevalence, impact, pathogenesis, differential diagnosis, and evaluation. Sleep Med Clin 2008; 3: 167-174
• 31 Geiger-Brown J, Lindberg S, Krachman S et al. Self- reported sleep quality and acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10: 389-397
• 32 Neville E, Walker AN, James DG. Prognostic factors predicting the outcome of sarcoidosis: an analysis of 818 patients. Q J Med 1983; 208: 525-533
• 33 Baughman RP, Lower EE. Features of sarcoidosis associated with chronic disease. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31: 275-281
• 34 Iwai K, Tachibana T, Takemura T et al. Pathological studies on sarcoidosis autopsy. I: Epidemiological features of 320 cases in Japan. Acta Pathol Jpn 1993; 43: 372-376
• 35 Swigris J, Olson A, Huie T et al. Sarcoidosis-related mortality in the United States from 1988 to 2007. Am J Crit Care Med 2011; 183: 1524-1530
• 36 Nardi A, Brillet P, Letoumelin P et al. Stage IV sarcoidosis: comparison of survival with the general population and causes of death. Eur Respir J 2011; 38: 1368-1373
• 37 Baughman RP, Judson MA. Relapses of sarcoidosis: what are they and can we predict who will get them?. Eur Respir J 2014; 43: 337-339
• 38 Walters AS. Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 1995; 10: 634-642