Prevalence of obstructive sleep apnea among patients with rheumatoid arthritis and its association with age and body mass index: A systematic review and meta‐analysis

Abstract

In a number of rheumatic diseases akin to rheumatoid arthritis (RA)-osteoarthritis, systemic lupus erythematosus, Sjögren syndrome, fibromyalgia, juvenile idiopathic arthritis, systemic sclerosis, spondyloarthritis, and Behçet syndrome-sleep abnormalities comprising reduced sleep, sleep fragmentation, and insomnia have been recognized. 1 Sleep apnea is an under-recognized comorbidity among rheumatology patients and its presence may adversely affect the evaluation of rheumatic disease activity and treatment responses. 2

Obstructive sleep apnea in patients with rheumatoid arthritis: The multidisciplinary approach and multidimensional assessment

“…1 Through 8 included studies which enrolled a total of 37 285 patients, a high prevalence of OSA was found in patients with RA, and body mass index appeared to be a major risk factor for OSA as well. 1 Considering the complexity of both OSA and RA, several aspects warrant further discussion.…”

“…We read with great interest the systematic review and meta‐analysis by Thakur et al on the prevalence and possible risk factors for obstructive sleep apnea (OSA) in patients with rheumatoid arthritis (RA) 1 . Through 8 included studies which enrolled a total of 37 285 patients, a high prevalence of OSA was found in patients with RA, and body mass index appeared to be a major risk factor for OSA as well 1 . Considering the complexity of both OSA and RA, several aspects warrant further discussion.…”

“…Patients with and without OSA were separated in the study by Thakur et al, using diagnostic criteria including the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), the Berlin questionnaire, and apnea-hypopnea index (AHI). 1 However, as the severity of OSA could be stratified by AHI, 2 subgroup analyses based on AHI could be employed to reflect the association between the severity of OSA and the incidence of RA. Aside from AHI, respiratory disturbance index (RDI) 3 and whether sleep surgeries 4,5 including tonsillectomy or adenoidectomy, uvulopalatopharyngoplasty, hyoid suspension, genioglossus advancement, or maxillomandibular advancement were performed may also indicate the severity of OSA.…”

“…The authors elaborated on the diagnostic criteria of OSA and mentioned different kinds of standards in the article; however, there was a lack of information on the diagnostic criteria for RA in the included studies. 1 During the past decades, a wide variety of diagnostic criteria for RA have been proposed, and the classification criteria approved by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR), referred to as the ACR/EULAR criteria, 11 were most often conformed to. As the knowledge of RA has gradually increased and the diagnostic technologies have become more advanced, the latest criteria have been launched in order to facilitate early diagnosis.…”

Unmet needs and perspectives in rheumatoid arthritis-associated interstitial lung disease: A critical review

“…Sleep disorders are frequently associated with RA. A recent meta-analysis has shown that the incidence of obstructive sleep apnea syndrome (OSAS) is 29.8% among RA cohorts, however with a significant heterogeneity, and high BMI is the principal risk factor ( 56 ). Although the epidemiology of sleep disorders is still blurred in RA-ILD, it is reasonable to consider OSAS as a significant complication in this subgroup of patients due to its relevance in other ILDs, including IPF, and can cause an extremely poor sleep quality that correlates with poor quality of life ( 57 , 58 ).…”