Researchers at Texas Tech University Health Sciences Center in El Paso have found a high prevalence of obstructive sleep apnea (OSA) in patients with rheumatoid arthritis. The results are accompanied by several complications, such as an increased risk of a higher body mass index (BMI) and a promising association with increasing age.

This was the most comprehensive meta-analysis on the prevalence of OSA in the rheumatic disease population, according to researchers involved in the study.

At the start of the study, the researchers, led by Bhaskar Thakur, PhD, addressed the important public health problem that OSA has presented in recent years.

Obstructive sleep apnea is characterized by recurrent apnea or hypopnea during sleep, the latter being defined as a 30% reduction in airflow for at least 10 seconds accompanied by a 4% reduction in saturation in oxygen.

Although OSA has been associated with an increased risk of cardiovascular disease as well as increased age, obesity or a higher BMI and a wider neck circumference, it remained a substantial deficit in the research published before the new study.

With their research, Thakur and his colleagues focused their attention on patients with rheumatoid arthritis in order to recognize the prevalence and risk factors of OSA in this population.

The study

A systematic literature search involving PubMed, Scopus, and EMBASE was conducted through October 30, 2020. In addition to this, up to 10 pages from the Google Scholar database were reviewed for relevant studies that could have been overlooked .

Investigators identified 94 records from 136 searched documents found in electronic databases and extracted a total of 8 unique studies from around the world. Of all the studies available, 3 were from the United States, with the remaining studies from Japan, Saudi Arabia, Taiwan, Egypt, and Brazil.

The 8 studies included 585 patients with OSA out of a total of 37,285 patients with rheumatoid arthritis. Most of the patients were women (78%), and the age range of all participants was between 40 and 67 years.

The reported disease duration range was 6 to 23 years.

Finally, a sensitivity analysis was carried out on the basis of the publication period and the diagnostic criteria of the studies collected.

Results

In a single study, sensitivity analyzes revealed that the prevalence of OSA was 79.3% of the study population. However, the study focused primarily on patients with rheumatoid arthritis and occipito-cervical lesions, which the researchers say may have contributed significantly to the observed heterogeneity.

When the Japanese study was excluded, the prevalence of OSA in patients with rheumatoid arthritis was reduced to 23.9%.

There was no reduction in the measure of heterogeneity in the study.

Overall, Thakur and the researchers observed that OSA was prevalent in 29.8% of rheumatoid arthritis patients, although previous data claimed the prevalence to be 50%.

Several studies have linked a high prevalence of OSA to occipitocervical lesions or occipitocervical disease. Additionally, previous evidence of rheumatoid arthritis causing damage to the upper cervical spine was referenced in the study, as investigators believed it to be a causative factor of both OSA and LOS. central sleep apnea.

An increase in BMI has also been associated with OSA in the rheumatoid arthritis population, although a lack of evidence has been noted.

Although the researchers showed a high level of heterogeneity in the prevalence of OSA in patients with rheumatoid arthritis, they also recommended ways to manage it by patients and healthcare professionals.

“Referral to a dedicated sleep clinic for further diagnostic evaluation and treatment as needed would be appropriate,” the team said. “Treatment of coexisting OSA in RA patients may prove beneficial in terms of future cardiovascular and respiratory morbidity, as well as potentially improving measures of inflammation, pain and fatigue. ”

The study, “Prevalence of obstructive sleep apnea in patients with rheumatoid arthritis and its association with age and body mass index: a systematic review and meta-analysis,” has been published online in the International Journal of Rheumatic Diseases.