Obstructive Sleep Apnea and Lymphocytic Sialadenitis: The Focus isn’t Just Sjögren’s Syndrome

Abstract

Objective: We examined the presence of lymphocytic infiltration and measured focus scores in uvular specimens of patients with obstructive sleep apnea (OSA). Methods: We reviewed the histopathology of 101 uvular specimens obtained from patients with OSA and uvular hypertrophy. A lymphocyte focus score assessment was performed for each case. Results: Of the 101 cases, 42 (42%) cases had a positive focus score (score ≥ 1). Of those cases with a positive focus score, 22 (52%) had a focus score of 1, 14 (33%) had a focus score of 2, 4 (9%) had a focus score of 3, and 2 (5%) had a focus score of 4. Of the 59 patients (58%) with negative focus scores, 39 (66%) had minor lymphocytic infiltrates; 17 (29%) had features of chronic sialadenitis or extensive fibrosis; 3 (5%) had salivary mucosa without any apparent lymphocytes. Conclusion: Our findings indicate that patients with OSA may exhibit focal lymphocytic sialadenitis (FLS). It remains to be determined whether mucosal changes occur elsewhere in the oral cavity of patients with OSA. If so, the presence of OSA may complicate the histologic evaluation of Sjogren’s syndrome. Further investigations to determine the prevalence of FLS in the uvulae of individuals without history of OSA, the extent of FLS elsewhere within the oral cavity of patients with OSA and the relationship between the local inflammatory reaction and the systemic consequences of OSA are needed.