{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:06:19Z","timestamp":1792069579742,"version":"4.4.0"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T00:00:00Z","timestamp":1512086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Obstructive sleep apnea (OSA) has been postulated to contribute to idiopathic pulmonary fibrosis by promoting alveolar epithelial injury via tractional forces and intermittent hypoxia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine whether OSA is associated with subclinical interstitial lung disease (ILD) and with biomarkers of alveolar epithelial injury and remodeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013hypopnea 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20136.8%; P\u2009=\u20090.003) and 35% increased odds of ILA (95% CI, 13\u201361%; P\u2009=\u20090.001). However, there was evidence that these associations varied by body mass index (BMI) (P for interaction\u2009=\u20090.08 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\u201312%; P\u2009=\u20090.03) and 2.3-fold increased odds of ILA (95% CI, 1.3\u20134.1; P\u2009=\u20090.005). 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\u20132.9; P\u2009=\u20090.01) but was not associated with HAA. There were no meaningful associations detected among those with a BMI of 25\u201330 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.201701-091oc","type":"journal-article","created":{"date-parts":[[2017,6,14]],"date-time":"2017-06-14T16:10:33Z","timestamp":1497456633000},"page":"1786-1795","source":"Crossref","is-referenced-by-count":61,"title":["Obstructive Sleep Apnea and Subclinical Interstitial Lung Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)"],"prefix":"10.1093","volume":"14","author":[{"given":"John S.","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Medicine, Columbia University Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna J.","family":"Podolanczuk","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Borker","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Kawut","sequence":"additional","affiliation":[{"name":"Department of Medicine and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Raghu","sequence":"additional","affiliation":[{"name":"Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel D.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Department of Medicine"},{"name":"Department of Environmental and Occupational Health Sciences and Department of Epidemiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen D. Hinckley","family":"Stukovsky","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Departments of Radiology, Medicine, and Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Graham","family":"Barr","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Medical Center, New York, New York"},{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Gottlieb","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts; and"},{"name":"Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan S.","family":"Redline","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, 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