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Volume 15 No. 11
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Accepted Papers

Scientific Investigations

Individuals With Scleroderma May Have Increased Risk of Sleep-Disordered Breathing

Brandon T. Nokes, MD1; Hassan A. Raza, MBBS2; Rodrigo Cartin-Ceba, MD3; Phillip J. Lyng, MD2; Lois E. Krahn, MD2,4; Lewis Wesselius, MD3; Clinton E. Jokerst, MD5; Sarah B. Umar, MD6; W. Leroy Griffing, MD7; Matthew R. Neville, MS8; Atul Malhotra, MD1; James M. Parish, MD2
1Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California; 2Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, Arizona; 3Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, Arizona; 4Division of Adult Psychiatry, Mayo Clinic Hospital, Phoenix, Arizona; 5Department of Radiology, Mayo Clinic, Scottsdale, Arizona; 6Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona; 7Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona; 8Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona

Study Objectives:

Scleroderma is associated with abnormal skin thickening, interstitial lung disease, pulmonary hypertension, and abnormalities of the upper airway. These changes can cause cardiopulmonary complications, potentially including sleep-disordered breathing. The objective of this study is to examine the risk of sleep-disordered breathing in patients with scleroderma.


We retrospectively identified patients with documented scleroderma. We abstracted data from their electronic health records, including findings from antibody tests, serial pulmonary function tests, transthoracic echocardiography, high-resolution computed tomography, and overnight forehead oximetry.


We identified 171 patients with scleroderma. Mean age at the time of initial consult was 56.5 years (range, 18–96 years), and 150 (86.7%) were women. Scleroderma was categorized as limited disease for 108 (62.4%), diffuse disease for 59 (34.1%), and mixed connective tissue disease for 6 (3.5%). Fifty-four patients (31.2%) had abnormal overnight forehead oximetry results, defined as an oxygen desaturation index greater than 5 or a baseline mean arterial oxygen saturation level less than 90%.


Cardiopulmonary complications are common in patients with scleroderma, one of which may be sleep-disordered breathing. In our cohort, approximately one-third of individuals with scleroderma had evidence of sleep-disordered breathing. Moreover, the rate of sleep-disordered breathing in our population of scleroderma patients was twice the rate of pulmonary hypertension and was approximately the same as the rate of interstitial lung disease. Future prospective studies are needed to further assess the role of sleep-disordered breathing in scleroderma clinical outcomes.


Nokes BT, Raza HA, Cartin-Ceba R, Lyng PJ, Krahn LE, Wesselius L, Jokerst CE, Umar SB, Griffing WL, Neville MR, Malhotra A, Parish JM. Individuals with scleroderma may have increased risk of sleep-disordered breathing. J Clin Sleep Med. 2019;15(11):1665–1669.

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