Risk of obstructive sleep apnea in patients with rheumatoid arthritis and its impact on quality of life

Background: Sleep fragmentation, fatigue and daytime sleepiness are common symptoms among rheumatoid arthritis (RA) patients (pts). Although some studies report that RA pts may be at higher risk for obstructive sleep apnea (OSA), these complaints are usually attributed to the RA itself and do not lead to further investigation. Objective: Find the prevalence of OSA in pts with RA and evaluate its impact on quality of life (QoL). Methods: We selected a random sample of RA-pts for a cross-sectional study. Disease Activity Score 28 (DAS28), Rheumatoid Arthritis Impact Disease (RAID), Health Assessment Questionnaire (HAQ), Epworth Sleepiness scale (ESS) and STOP-Bang scale (SBS) were applied. Pts with moderate-to-high suspicion for OSA underwent cardiorespiratory polygraphy (PG). Spearman and Chi-square tests were used for comparisons. Results: 38 pts were included with average age of 59.63y (±13.1) and 32 (84.2%) were women. All had at least one cardiovascular risk factor. We identified 10 (26.3%) pts with moderate-to-high risk for OSA; 7 accepted to underwent PG and 6 of them had an apnea-hypopnea index (AHI)>5/h. These high-risk group had: BMI>25 kg/m2 in 90%, SBS>3 in 80%, ESS>13 in 60% and a median DAS28 of 5.27 (vs. 3.18), RAID of 5.27 (vs. 3.18) and HAQ of 1 (vs. 0.9). None of these had statistical significance. The mean AHI was 12.7/h - 4 mild and 2 moderate OSA. Conclusions: Despite the small sample and the possible underdiagnosis by simple PG, we highlight the elevated prevalence (26.3%) of non-previously diagnosed OSA. Finally, pts with higher risk for OSA also seems to have a worse impact of RA on their QoL and ESS/SBS could be effective in the screening of these pts.