A Case of Rheumatoid Arthritis and Obstructive Sleep Apnea (2025)

Prevalence of obstructive sleep apnea in patients with rheumatoid arthritis

Journal of Clinical Sleep Medicine, 2020

Study Objectives: Although previous studies suggested an increased prevalence of obstructive sleep apnea (OSA) among patients with rheumatoid arthritis (RA), no existing large prospective study has addressed this association using objective measures. This study aims to assess the prevalence of OSA using polysomnography (PSG) in patients with RA and its relationship with RA activity. Methods: Patients with RA who presented at the rheumatology clinic at a university hospital from 2017 to 2018 were eligible. In the first stage, data from the Disease Activity Score 28, Berlin questionnaire, and Epworth Sleepiness Scale were obtained, along with personal data and a comprehensive medical history. The second stage involved a case-control study confirming OSA with PSG. OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/h, whereas patients with an AHI ≥ 15 events/h were categorized as having moderate-severe OSA. Results: In total, 199 patients with RA were recruited, 110 patients (55%) underwent PSG, and 5 were excluded. The mean age was 48.93 ± 12.7 years, and the mean body mass index was 31.70 ± 9.74 kg/m 2 ; 94% were female. In total, 67 participants (33.2%) were at high risk for OSA (36 [55.4%] underwent PSG), whereas 132 (66.8%) were at low risk (69 [51.5%] underwent PSG). The estimated prevalence of OSA (AHI ≥ 5 events/h) in the whole population was 58.1%, whereas the prevalence of moderate-to-severe OSA (AHI ≥ 15) was 22.9%. Conclusions: This prospective PSG-based study demonstrated that OSA is more common in patients with RA than in the general population, but there appears to be no relationship with disease activity.

Do Rheumatoid Arthritis Patients Have a Higher Risk for Sleep Apnea?

The Journal of Rheumatology, 2009

Objective.Patients with rheumatoid arthritis (RA) have an increased risk for developing cardiovascular disease (CVD) compared to subjects in the general population. The development of CVD has also been linked to chronic sleep apnea. The purpose of this study was to examine the risk for sleep apnea in patients with RA compared to subjects without RA.Methods.We recruited RA patients and non-RA subjects who were age and sex matched from the same population. These persons completed the Berlin Sleep Questionnaire, which evaluated their level of risk (high or low) for sleep apnea. In addition, there were 3 subscales evaluating snoring, fatigue, and relevant comorbidities [i.e., high blood pressure and obesity [body mass index (BMI) ≥ 30 kg/m2)]. Chi-squared tests were used for comparisons.Results.The study population consisted of 164 patients with RA and 328 patients without RA. Age, sex and BMI were similar for both groups. There was no difference in snoring (p = 0.31) or in the comorbid...

Frequency of sleep disorders in patients with rheumatoid arthritis

Open Access Rheumatology: Research and Reviews

To determine the prevalence of common sleep problems among patients with rheumatoid arthritis (RA) and their relationship with the disease activity and quality of life. Patients and methods: The study sample consisted of 101 patients who attended a rheumatology clinic at a university hospital between October 2015 and May 2016. All subjects were clinically examined and interviewed by physicians using a questionnaire. The collected information included sociodemographic characteristics, the patients' medical histories, the Disease Activity Score (DAS28), the Berlin questionnaire to assess the risk of obstructive sleep apnea (OSA), the Epworth Sleepiness Scale to assess excessive daytime sleepiness (EDS), the Athens Insomnia Scale to assess insomnia, the International RLS Study Group score to diagnose restless legs syndrome (RLS), and the Health Assessment Questionnaire (HAQ) to assess the quality of life. Results: The mean age of the participants was 48.7±14.6 years, and 95% of the participants were females. Approximately 60% of the participants were in the remission/low category of disease activity, and the average DAS28 score was 3.3±0.8 years. The prevalence rates of insomnia, EDS, sleep disturbance, risk of OSA, and RLS were 63%, 20%, 20%, 37%, and 63%, respectively. Furthermore, the distribution of sleep disorders was not affected by the disease activity. The association between the HAQ and sleep disorders among the RA patients was not significant. Conclusion: Sleep disorders are common among RA patients and may require further attention by treating clinicians; nevertheless, these disorders are not associated with disease activity and do not affect the quality of life.

Sleep disorders and vascular responsiveness in patients with rheumatoid arthritis

Journal of Internal Medicine, 2020

BackgroundRheumatoid arthritis (RA) is the most common systemic autoimmune disease characterized by chronic systemic inflammation. Half of the deaths of patients with RA are due to cardiovascular diseases (CVD), considered to be 1.5 to −2.0‐fold that in the general population. Patients with RA also experience poor sleep, which by itself is associated with endothelial dysfunction, CVD events and sudden death. Our aim was to study the mechanistic pathways and the correlations between sleep efficiency and vascular reactivity of patients with RA.Methods and resultsA prospective study that evaluated quality of sleep using ACTi Graphs, vascular inflammation and endothelial function of 18 patients with RA. Inflammation was studied by levels of E‐selectin, intercellular adhesion molecule 1 (ICAM‐1) and NO in serum. Endothelial function was studied using the brachial artery plethysmography method. Eighteen RA patients (aged 57.56 ± 13.55 years; 16 women) with a long‐standing active RA: Eight...

Sleep and rheumatologic disorders

Sleep Medicine Reviews, 2008

Arthritis is the leading cause of chronic illness in the United States. Seventy-two percent of the adults aged 55 years and older with arthritis report sleep difficulties. This review discusses sleep disorders associated with rheumatoid arthritis, juvenile rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, scleroderma, Behcet's disease, seronegative spondyloarthropathies, osteoarthritis, sarcoidosis, and fibromyalgia. We describe the inter-relationship between sleep complaints, disease activity, depression, sleep deprivation, and cytokines. An algorithm for evaluation and treatment of sleep disorders associated with rheumatologic diseases is proposed.

Fatigue and sleep disturbances as common problems in life of patients with rheumatoid arthritis

Kontakt, 2015

Obstructive sleep apnea is a risk factor for osteoarthritis

Tüberküloz ve toraks, 2018

Obstructive sleep apnea is a risk factor for osteoarthritis Introduction: Obstructive sleep apnea (OSA) syndrome is closely associated with cardiovascular and metabolic disorders. Recent studies reported that osteoarthritis (OA) is associated with cardiovascular disease as well as inflammation defined as "metabolic disorder". Due to the strong association of metabolic

Obstructive Sleep Apnea Syndrome: An Under -recognized Clinical Entity with Significant Systemic Morbidities

RUHS Journal of Health Science, 2018

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent yet under recognized sleep disorder, characterized by repeated disruptions of breathing during sleep. Not just merely a local phenomenon of upper respiratory tract obstruction, this has many consequences that includes intermittent hypoxia, intermittent hypercapnia, reoxygenation, intra thoracic pressure changes, sympathetic activation, micro-awakenings and sleep fragmentation leading to metabolic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress, hypercoagulation, and neurohumoral changes that causes excessive daytime sleepiness, neurocognitive deterioration, endocrine, metabolic and other systemic effects including poor quality of life. There are increasing evidences to suggest that OSAS is a systemic inflammatory disease. Epidemiological studies have identified OSAS as an independent risk factor in cardiovascular diseases, metabolic syndrome and bronchial asthma. Patho-physiological changes in OSAS are causally linked to the hypertension with increase risk for heart failure, stroke and cardiovascular mortality. In addition, OSAS is associated with several other disorders and comorbidities that may affect almost every organ systems of our body. Despite having many complex systemic consequences, OSAS and its secondary effects are mostly controllable by continuous positive air pressure (CPAP). This disorder largely remains an underestimated clinical entity due to unawareness by both the patient and physician alike. There is need for awareness regarding this entity among all specialties of medicine and surgery as the so called undetected/occult disease if remain untreated may lead to significant systemic morbidities and at times mortality. like micrognathia, retrognathia, high arched palate, macroglossia, nasal polyp, deviated nasal septum, genetic predisposition, familial aggregation, cigarette smoking, menopause, alcohol intake, night time nasal congestion, endocrine abnormalities (hypothyroidism/acromegaly, polycystic ovarian syndrome), Down's syndrome, drugs like benzodiazepines, muscle relaxants, testosterone therapy7'8 etc. Recently bronchial asthma, chronic obstructive pulmonary disease (COPD), metabolic syndrome, certain psychiatric problems etc has also emerged as important risk factors for development of OSAS. Poor control of these disorders has been consistently associated with poor sleep, restlessness, breathlessness and poor quality of life among these patients.

OP0267-HPR “I Never Thought Exercise Could Help Improve My Sleep”: Experiences of People with Rheumatoid Arthritis on the Impact of Exercise on Sleep

Annals of the Rheumatic Diseases, 2020

Background: Work disability is an important outcome in the treatment of Spondyloarthritis (SpA) since this disease affects people in the most productive stage of life. Objectives: The aim of this study is to investigate the working status and the factors associated with work productivity loss (WPL) in patients with axial (axSpA) and peripheral SpA (pSpA). Methods: Patients with SpA according to ASAS criteria were included consecutively in this multicentric cross-sectional study. Evaluation of activity through a visual analogue scale (0-100), enthesitis (LEI), functional capacity (HAQ and BASFI), disease activity (DAS28 and BASDAI), health status (ASAS Health Index) and quality of life (ASQoL) were calculated. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was recorded. The Work Productivity and Activity Impairment Spondyloarthritis (WPAI SpA) questionnaire was used to assess work productivity. Spearman's correlation coefficient (ρ) was used to assess the correlation with the percentage of WPL. Results: 274 patients with SpA were recruited, 129 (47.1%) with axSpA and 145 (52.9%) with pSpA. 56.6% were women and 33.2% stopped working due to the underlying disease. Among axSpA patients, 70% were radiographic and 30% non radiographic, mean age 45.5 (SD14) yrs, median disease duration 72 (IQR 36-144) months and diagnosis delay 20 (IQR 11-70) months. 45.7% were employed, median hours worked in the last week was 40 (IQR 25-45), median scores for absenteeism was 0% (IQR 0-2), presenteeism 30% (IQR 5-40), WPL 30% (IQR 10-52.5) and activity impairment 30% (IQR 10-50). A positive correlation was found between WPL and the following variables: HAQ (ρ:0.40, p<0.001), BASDAI (ρ:0.48, p<0.001), ASDAS (ρ:0.46, p<0.001), BASFI (ρ:0.59, p<0.001), ASQoL (ρ:0.60, p<0.0001), LEI (ρ:0.31, p:0.02) and ASAS health index (ρ:0.54, p<0.001). Among pSpA patients, mean age was 52.3 (SD13) yrs, median disease duration 60 (IQR 14-120) months and diagnosis delay 12 (IQR 3-24) months. 46.9% were employed, median hrs worked in the last week was 30 (IQR 14-40), absenteeism 0% (IQR 0-7), presenteeism 30% (IQR 2.5-58), WPL 30% (IQR 5-52) and activity impairment 20% (IQR 0-40). A positive correlation was found between WPL and: HAQ (ρ:0.49, p<0.001), ASDAS (ρ:0.58, p<0.001), ASQoL (ρ:0.57, p<0.0001), DAS28 (ρ:0.50, p<0.001), LEI (ρ:0.36, p:0.04) and ASAS health index (ρ:0.52, p<0.001). No statistically significant differences were found in absenteeism, presenteeism, WPL and activity impairment between axSpA and pSpA. Conclusion: Our study showed that WPL in this national cohort was 30% in both groups of patients and is associated with disease activity, enthesitis, health status, quality of life and functional ability.

Investigation into sleep and quality of life in patients with rheumatoid arthritis

International journal of human sciences, 2014

Aim of this study is to examine the relationship between the sleep and life of rheumatoid arthritis patients and the factors affecting this relationship. Method and material: This research is a descriptive design study. This study was conducted in the Rheumatology polyclinic of a university hospital between January 2011 and June 2011 in İzmir/Turkey. Simple random sampling method was used in this study. The data of the research were collected through face-to-face interviews. "Patient Identification Form", "Pittsburg Sleep Quality Index" and "Nottingham Health Profile" scale were used for data collection. Results: In Pittsburg Sleep Quality Index, total score average of the rheumatoid arthritis patients was found out to be 10.92±4.80. Score averages of the sub-scales of Nottingham Health Profile were found as following: