Sleep Apnea: Is RA Connected with Sleep Apnea? (Part One)

Patient Expert

Earlier this month, I was diagnosed with mild sleep apnea.   My rheumatologist suspected the condition after I reported certain symptoms, including increased depression, anxiety, and daytime sleepiness which can be extraordinarily dangerous.   Sleep apnea increases the risk of cardiovascular disease, as does having RA.   My doctor insisted that I be evaluated and after receiving the sleep study results, she encouraged me to pursue treatment.

What Is Sleep Apnea?

Sleep apnea is a chronic condition characterized by disrupted breathing during sleep.   Pauses in breathing and/or overly shallow breathing (hypopnea) can last from seconds to minutes and may occur more than 30 times per hour.   Sleep apnea often goes undiagnosed, but is estimated to affect 22 million Americans, according to the American Sleep Apnea Association.

The most common type of sleep apnea is obstructive sleep apnea (OSA) in which the airway collapses or becomes blocked during sleep.   Loud snoring, snorting, and/or gasping for air may occur as a result.   OSA is more common in people who are overweight.

Central sleep apnea, which is less common, occurs if your brain fails to send the correct signals to your breathing muscles.   You are not likely to snore with central sleep apnea as your body simply makes no effort to breathe for brief periods of time.   Central sleep apnea and obstructive sleep apnea can occur independently or concurrently.

Untreated sleep apnea can lead to depression, heart disease, diabetes, obesity, and excessive daytime sleepiness.   Stress hormones released during frequent drops in blood oxygen level caused by sleep apnea increase the risk of high blood pressure, heart attack, stroke, irregular heart beats (arrhythmias) and heart failure.   Excessive sleepiness can lead to fatal car crashes and accidents at work.

What are the signs and symptoms of sleep apnea?

One of the most common signs of obstructive sleep apnea is loud and chronic snoring, interrupted with pauses and choking or gasping sounds.   A family member will often notice these problems before you do (as you're asleep when it happens).   But not everyone who snores has sleep apnea.

Another common sign of OSA is fighting sleepiness during the day, or even insomnia at night.   Others signs and symptoms of sleep apnea include:

-     Morning headaches

-     Memory or learning problems and not being able to concentrate

-     Feeling irritable, depressed, or having mood swings or personality changes

-     Waking up frequently to urinate

-     Dry mouth or sore throat when you wake up

In children, sleep apnea can cause hyperactivity, poor school performance, and angry or hostile behavior. Children who have sleep apnea also may breathe through their mouths instead of their noses during the day.

Are RA patients at increased risk of sleep apnea?

Sleep apnea occurs more frequently in men than in women.   A family history of sleep apnea and obesity increase your risk of developing the condition.   Other risk factors include getting older and small airways, caused by enlarged tonsils, congestion, or anatomical structures.

A study published in 2009 examined the risk of sleep apnea in 164 RA patients as compared to 328 patients without RA.   Study participants completed a physical exam and the Berlin Sleep Questionnaire.   Responses to questions related to three categories of known risk factors for sleep apnea (snoring, fatigue, and comorbidities) were scored to produce an indicator of high/low risk for each category and combined to calculate an overall risk for sleep apnea.   Age, sex, and BMI (body mass index) were similar for both groups.

The Questionnaire showed that 82 (50%) of the RA patients and 101 (31%) of the non-RA subjects were at a high risk of having sleep apnea.   No difference was found in the snoring subscale (48% for the RA patients and 44% for the non-RA subjects) or in the comorbidities subscale (59% for the RA patients and 54% for the non-RA subjects).   However, more RA patients reported fatigue (38%) than subjects without RA (13%).

Among the 164 RA patients, 23 (14%) already had a diagnosis of OSA.   Of those, 16 patients scored high for overall risk of sleep apnea on the Questionnaire, representing only 20% of RA patients at high risk for OSA.   Researchers suggest that OSA is under-diagnosed in the RA population.

Continue reading Sleep Apnea: How is it Diagnosed and Treated? Part Two.

National Heart Lung and Blood Institute (NHLBI).   What Is Sleep Apnea?

Holman AJ.   Considering cardiovascular mortality in patients with rheumatoid arthritis from a different perspective: a role for autonomic dysregulation and obstructive sleep apnea. J Rheumatol 2007;34:671-673.

Reading SR, et al. Do Rheumatoid Arthritis Patients Have a Higher Risk for Sleep Apnea? J Rheumatol 2009 September;36(9):1869-1872. doi:10.3899/jrheum.081335.

American Sleep Apnea Association - Sleep Study Details.

In this series:

Sleep Apnea: Is RA Connected with Sleep Apnea? (Part One)

Sleep Apnea: How is it Diagnosed and Treated? (Part Two)

Multiple Sclerosis and Sleep Disorders: Do You Suffer Fatigue and Daytime Sleepiness? (Part Three)