AB0388 IMPROVEMENT OF PATIENT-REPORTED OUTCOMES IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME UNDERGOING CPAP-TREATMENT
Authors: M. Seng, B. C. Frye, L. Vollmer, F. Kollert, R. Voll, S. Finzel
Journal: Annals of the Rheumatic Diseases (2020)

Background: Fatigue is a frequent symptom in primary Sjögren’s Syndrome (pSS) determining health-related quality of life in many patients. Earlier studies could show that sleep apnea syndrome (SAS) is associated with patient-reported outcomes in pSS-patients [1]. Objectives: To investigate whether treatment of an underlying SAS improves disease activity in pSS-patients. Methods: 14 female pSS-patients from our rheumatology outpatient clinic were enrolled and screened for SAS; continuous positive airway pressure (CPAP)-treatment was initiated in patients with a sleep apnea/hypopnea index &gt;5/h and a respiratory disturbance index &gt;15/h sleeping time (pSS treated with CPAP: pSS+; pSS untreated: pSS-). As controls, 11 SAS-patients (4 female) scheduled for initiation of CPAP-treatment were recruited from pulmonology department. In pSS, ESSDAI, ESSPRI, pain and patient global health on a visual analogue scale from 0-100mm were recorded. In both groups CRP, ESR, depression (PHQ-9), fatigue (FACIT), daytime sleepiness (EPS), and salivary gland ultrasound (SGUS) of the parotid and submandibular glands (PG; SMG) were obtained [2]. Data were collected at baseline (BL) and month 3 (M3). A p-value &lt;0.05 was deemed significant. Results: 6 pSS-patients were diagnosed with SAS and underwent CPAP-initiation, as well as all SAS-patients. Table 1 shows means ± SD of all assessments. EPS indicated normal sleep propensity in all groups at both time points. Fatigue was severe in all groups at BL. Numerically in SAS and pSS+, fatigue and depression trended towards improvement between BL and M3. Depression scores were moderate in all groups at BL; in SAS, PHQ-9 score showed a trend towards improvement at M3. SGUS grades 0 or 1 (i.e. normal or unspecific SGUS pattern) were found in 46.43% of PG and SMG at BL, in 40.39% at M3 in pSS, and in 100% in SAS at both time points. Grades 2 or 3 (pSS-typical US-pattern or gland destruction) were exclusively found in pSS at BL (53.57%) and M3 (59.62%). pSS-SGUS scores worsened irrespective of CPAP-treatment. Conclusion: Even though this is only preliminary data of a small fraction of patients who completed M3 so far, there is already a clear tendency towards reduced fatigue, inflammatory markers and depression both in the CPAP-treated pSS and in the SAS-patients compared to the non-CPAP-treated pSS-patients. References: [1]Usmani ZM Sleep Medicine 2012; 2. Jousse-Joulin S Ann Rheum Dis. 2019 Baseline (mean±SD) Month 3 (mean±SD) p-Values CRP pSS+ 4.58±2.98 2.79±0.56* *p=0.014 pSS- 6.53±5.07 4.08±3.69 SAS 4.27±1.80 4.76±3.50* ESR pSS+ 30.50±21.92 24.75±10.69 + + p=0.031 pSS- 34.75±37.92 47.29±37.82 ^ ^ p=0.013 SAS 20.67±17.56 11.67±11.38 +^ ESSDAI pSS+ 10.67±4.97 11.00±6.08 pSS- 11.63±3.25 9.43±4.72 ESSPRI pSS+ 6.75±1.44” 6.47±1.75 “p=0.037 pSS- 5.18±1.32” 5.46±1.77 VAS pain pSS+ 55.83±21.61° 54.17±24.60 °p=0.037 pSS- 27.50±26.33° 34.25±26.87 VAS PGH pSS+ 58.50±11.67 56.00±19.54 pSS- 52.88±30.86 53.00±23.05 FACIT pSS+ 24.00±6.03 29.00±10.56 ¥ ¥ p=0.059 pSS- 27.88±14.75 30.50±12.54 SAS 29.36±10.46 Δ 37.82±10.73 ¥Δ Δ p=0.054 PHQ-9 pSS+ 11.50±3.02 9.33±3.88∞ pSS- 10.86±5.05 9.00±2.51® SAS 10.11±5.33× 6.55±5.75×®∞ × p=0.059; ®p=0.068; ∞p=0.087 Disclosure of Interests: Magdalena Seng: None declared, Björn Christian Frye: None declared, Lydia Vollmer: None declared, Florian Kollert Employee of: Novartis, Reinhard Voll: None declared, Stephanie Finzel: None declared