A recent study revealed that 58% of rheumatoid arthritis (RA) patients also suffer from obstructive sleep apnea (OSA), significantly higher than the general population’s rate of 22%. RA, an autoimmune disease affecting 1.3 million Americans, causes chronic inflammation, joint pain, and fatigue, while OSA disrupts breathing during sleep, leading to poor sleep quality and increased health risks like heart disease and diabetes.
The study found no direct link between OSA severity and RA activity but highlighted obesity as a contributing factor, with participants averaging a BMI of 31.7. Routine OSA screening for RA patients could improve health outcomes, emphasizing the need for accurate diagnostic tools like polysomnography and comprehensive treatment approaches.
The RA-OSA Study
Researchers ran a large study to understand the link between obstructive sleep apnea (OSA) and rheumatoid arthritis (RA). They collected data through patient evaluations, questionnaires, and sleep tests. Moreover, advanced strategies were used to provide accurate results. Every effort is focused on finding valuable insights.
Who Participated in the Study?
The study looked at people with rheumatoid arthritis (RA) who went to a university hospital’s rheumatology clinic between 2017 and 2018. Researchers included 199 patients in total.
Nearly all participants—94%—were women, which isn’t surprising since RA is much more common in females. The average age was nearly 49 years, and participants had a mean body mass index (BMI) of 31.7—falling into the overweight or obese range, which is a known risk factor for OSA.
What Was the Study Trying to Measure?
The main goal was to find out how many RA patients had OSA. To do this, the researchers wanted to:
- Determine who was at high risk for OSA using questionnaires.
- Confirm the presence and severity of OSA using overnight sleep tests.
- Explore whether OSA was linked to RA disease activity.
What Tools and Methods Did Researchers Use?
The study was conducted in two stages:
1. Screening Stage
The first step involved identifying patients who might have OSA. Researchers used three widely accepted tools:
- Berlin Questionnaire: This assesses the likelihood of OSA based on symptoms like snoring, fatigue, and risk factors like high BMI.
- Epworth Sleepiness Scale: A quick test to measure daytime sleepiness. Scores help determine if someone is experiencing abnormal fatigue, often caused by poor-quality sleep.
- Disease Activity Score 28 (DAS28): This evaluated the severity of RA. It’s a standard tool that measures joint swelling, tenderness, and inflammation markers in blood tests.
In addition to these tests, researchers also gathered detailed medical histories from participants. They included information about lifestyle habits and existing health conditions.
2. Confirmation Stage
The second stage was more technical. Researchers conducted polysomnography (PSG), also called an overnight sleep study, on a subset of participants. PSG is considered the gold standard for diagnosing OSA. It monitors:
- Breathing patterns
- Oxygen levels in the blood
- Heart rate
- Brain activity
- Limb movements during sleep
OSA was diagnosed if a participant had an Apnea-Hypopnea Index (AHI) of ≥ 5 events per hour. Moderate-to-severe OSA was defined as an AHI of ≥ 15 events per hour.
How Many Patients Completed the Sleep Study?
Out of the 199 participants, 110 (55%) completed the overnight PSG. Five were excluded from the analysis due to insufficient data. Among those who participated:
- 67 patients (33.2%) were classified as high risk for OSA.
- 132 patients (66.8%) were classified as low risk for OSA.
Interestingly, both high-risk and low-risk groups underwent PSG at similar rates (55.4% and 51.5%, respectively).
What Did the Study Find?
Among RA patients, 58.1% were found to have obstructive sleep apnea (OSA). This rate is far higher than the 22% seen in the general population.
Moderate-to-severe OSA was identified in 22.9% of patients. Researchers measured this as 15 or more breathing interruptions per hour during sleep. No direct link was found between how severe OSA was and the activity level of RA.
One limitation of this study is that it only included patients from a single hospital, which means the findings might not represent all people with rheumatoid arthritis. Additionally, the study didn’t look at specific factors like jaw or neck issues that could increase the risk of sleep apnea in these patients.
Why Was Polysomnography Important?
Polysomnography helped make the study results accurate and reliable. Many earlier studies only used questionnaires, which aren’t always precise. Questionnaires can overlook some cases or exaggerate how common OSA is. Using PSG provided researchers with clear and precise data about OSA in RA patients.
Takeaways from the Study
- OSA is significantly more common in RA patients than in the general population. Over half of the participants had OSA, highlighting the need for routine screening in this group.
- BMI and obesity likely contribute to the high prevalence. With a mean BMI of 31.7, many participants were at an increased risk for OSA due to their weight.
- Disease activity in RA doesn’t seem directly linked to OSA severity. This finding suggests that OSA may affect RA patients independently of their joint inflammation levels.
How Can the Insomnia and Sleep Institute of Arizona Help You?
Struggling with Rheumatoid Arthritis and sleep problems like obstructive sleep apnea (OSA) at the same time can be overwhelming. The Insomnia and Sleep Institute of Arizona specializes in diagnosing and treating all types of sleep disorders. Our team is here to provide professional care and help you find lasting relief.
Why Choose Us?
- Experienced Specialists: Our team of board-certified sleep experts has years of experience helping people with all kinds of sleep problems.
- Advanced Testing: We use top-notch tools like overnight sleep studies (PSG) and at-home tests to give you an accurate diagnosis.
- Personalized Treatments: Whether it’s CPAP therapy, Inspire therapy, or other options, we design treatments that work best for you.
- Care for Everyone: From kids to adults, we provide personalized care to improve sleep and overall health for the long term.
- Convenient Locations: Visit us in Phoenix, Gilbert, or Scottsdale for expert sleep care close to home.
What Can You Expect?
We focus on providing expert and compassionate care from the moment you visit. Your symptoms are evaluated thoroughly to understand your needs. Advanced diagnostic tests are used to pinpoint the problem. A treatment plan is created to fit your daily life. No matter how mild or severe your OSA is, we focus on delivering the best care for you.
Take the First Step Today
At the Insomnia and Sleep Institute of Arizona, we help individuals regain control of their sleep and health. Contact us today to schedule a consultation. Experience the difference that our expert care can make.
References
Wali, S., Mustafa, M., Dilshad Manzar, Yasser Bawazir, Attar, S., Fathaldin, O., Sami Bahlas, Roaa Alsolaimani, Faris Alhejaili, & Abdelaziz, M. (2020). Prevalence of obstructive sleep apnea in patients with rheumatoid arthritis. Journal of Clinical Sleep Medicine, 16(2), 259–265. https://doi.org/10.5664/jcsm.8178
Disclaimer: The information provided in this blog post is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a licensed healthcare provider for recommendations specific to your individual health needs.
