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Wilton KM, Matteson EL, Crowson CS. Risk of Obstructive Sleep Apnea and Its Association with Cardiovascular and Noncardiac Vascular Risk in Patients with Rheumatoid Arthritis: A Population-based Study. J Rheumatol 2017; 45:45-52. [PMID: 28765254 DOI: 10.3899/jrheum.170460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To define the incidence of obstructive sleep apnea (OSA) in patients with rheumatoid arthritis (RA) and determine whether OSA diagnosis predicts future cardiovascular disease (CVD) and noncardiac vascular events. METHODS Medical information pertaining to RA, OSA, CVD, and vascular diagnoses was extracted from a comprehensive medical record system for a geographically defined population of 813 patients previously diagnosed with RA and 813 age- and sex-matched comparator subjects. RESULTS The risk for OSA in persons with RA versus comparators was elevated, although not reaching statistical significance (HR 1.32, 95% CI 0.98-1.77; p = 0.07). Patients with RA were more likely to be diagnosed with OSA if they had traditional risk factors for OSA, including male sex, current smoking status, hypertension, diabetes, dyslipidemia, and increased body mass index. Features of RA disease associated with OSA included large joint swelling and joint surgery. Patients with RA with decreased renal function were also at higher risk of OSA. The increased risk of overall CVD among patients with RA who have OSA was similar to the increased CVD risk associated with OSA in the comparator cohort (interaction p = 0.86). OSA diagnosis was associated with an increased risk of both CVD (HR 1.9, 95% CI 1.08-3.27), and cerebrovascular disease (HR 2.4, 95% CI 1.14-5.26) in patients with RA. CONCLUSION Patients with RA may be at increased risk of OSA secondary to both traditional and RA-related risk factors. Diagnosis with OSA predicts future CVD in RA and may provide an opportunity for CVD intervention.
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Affiliation(s)
- Katelynn M Wilton
- From the Mayo Clinic School of Medicine; Mayo Clinic Graduate School of Biomedical Sciences; Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,K.M. Wilton, BS, MD/PhD Student, Mayo Clinic School of Medicine, and Mayo Clinic Graduate School of Biomedical Sciences; E.L. Matteson, MD, MPH, Professor of Medicine, Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic; C.S. Crowson, MS, Associate Professor of Medicine, Department of Health Sciences Research, Mayo Clinic
| | - Eric L Matteson
- From the Mayo Clinic School of Medicine; Mayo Clinic Graduate School of Biomedical Sciences; Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,K.M. Wilton, BS, MD/PhD Student, Mayo Clinic School of Medicine, and Mayo Clinic Graduate School of Biomedical Sciences; E.L. Matteson, MD, MPH, Professor of Medicine, Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic; C.S. Crowson, MS, Associate Professor of Medicine, Department of Health Sciences Research, Mayo Clinic
| | - Cynthia S Crowson
- From the Mayo Clinic School of Medicine; Mayo Clinic Graduate School of Biomedical Sciences; Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA. .,K.M. Wilton, BS, MD/PhD Student, Mayo Clinic School of Medicine, and Mayo Clinic Graduate School of Biomedical Sciences; E.L. Matteson, MD, MPH, Professor of Medicine, Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic; C.S. Crowson, MS, Associate Professor of Medicine, Department of Health Sciences Research, Mayo Clinic.
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Shen TC, Hang LW, Liang SJ, Huang CC, Lin CL, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC. Risk of obstructive sleep apnoea in patients with rheumatoid arthritis: a nationwide population-based retrospective cohort study. BMJ Open 2016; 6:e013151. [PMID: 27895064 PMCID: PMC5168499 DOI: 10.1136/bmjopen-2016-013151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Sleep disorders are prevalent medical disorders in patients with rheumatoid arthritis (RA). However, whether patients with RA are at an increased risk of developing obstructive sleep apnoea (OSA) is unclear. DESIGN Using population-based retrospective cohort study to examine the risk of OSA in patients with RA. SETTING We used claims data of the National Health Insurance Research Database (NHIRD) of Taiwan. PARTICIPANTS We identified a RA cohort with 33 418 patients newly diagnosed in 2000-2010 and a randomly selected non-RA comparison cohort with 33 418 individuals frequency matched by sex, age and diagnosis year. PRIMARY AND SECONDARY OUTCOME MEASURES Incident OSA was estimated by the end of 2011. The HRs of OSA were calculated using the Cox proportional hazards regression analysis. RESULTS The overall incidence rate of OSA was 75% greater in the RA cohort than in the non-RA cohort (3.04 vs 1.73/10 000 person-years, p<0.001), with an adjusted HR (aHR) of 1.75 (95% CI 1.18 to 2.60). Stratified analyses by sex, age group and comorbidity revealed that the incidence rates of OSA associated with RA were higher in all subgroups. CONCLUSIONS This population-based retrospective cohort study suggested that patients with RA should be monitored for the risk of developing OSA.
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Affiliation(s)
- Te-Chun Shen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
- Intensive Care Unit, Chu Shang Show Chwan Hospital, Nantau, Taiwan
| | - Liang-Wen Hang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
- Sleep Medical Center, China Medical University Hospital, Taichung, Taiwan
| | - Shinn-Jye Liang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
- Sleep Medical Center, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Chung Huang
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Immunology and Rheumatology, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yen Tu
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Hsia
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chuen-Ming Shih
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- College of Public Health, Kunming Medical University, Kunming, YuanNan, China
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Goes ACJ, Reis LAB, Silva MBG, Kahlow BS, Skare TL. Rheumatoid arthritis and sleep quality. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 57:294-298. [PMID: 28743355 DOI: 10.1016/j.rbre.2016.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/15/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Sleep disturbances are common in rheumatoid arthritis (RA) patients and contribute to loss of life quality. OBJECTIVE To study associations of sleep quality with pain, depression and disease activity in RA. METHODS This is a transversal observational study of 112 RA patients submitted to measurement of DAS-28, Epworth scale for daily sleepiness, index of sleep quality by Pittsburg index, risk of sleep apnea by the Berlin questionnaire and degree of depression by the CES-D (Center for Epidemiologic Studies Depression scale) questionnaire. We also collected epidemiological, clinical, serological and treatment data. RESULTS Only 18.5% of RA patients had sleep of good quality. In univariate analysis a bad sleep measured by Pittsburg index was associated with daily doses of prednisone (p=0.03), DAS-28 (p=0.01), CES-D (p=0.0005) and showed a tendency to be associated with Berlin sleep apnea questionnaire (p=0.06). In multivariate analysis only depression (p=0.008) and Berlin sleep apnea questionnaire (p=0.004) kept this association. CONCLUSIONS Most of RA patients do not have a good sleep quality. Depression and risk of sleep apnea are independently associated with sleep impairment.
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Affiliation(s)
| | | | - Marilia Barreto G Silva
- Hospital Universitário Evangélico de Curitiba, Unidade de Reumatologia, Curitiba, PR, Brazil
| | - Barbara Stadler Kahlow
- Hospital Universitário Evangélico de Curitiba, Unidade de Reumatologia, Curitiba, PR, Brazil
| | - Thelma L Skare
- Hospital Universitário Evangélico de Curitiba, Unidade de Reumatologia, Curitiba, PR, Brazil.
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Treatment management of children with juvenile idiopathic arthritis with temporomandibular joint involvement: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:581-589.e2. [DOI: 10.1016/j.oooo.2014.01.226] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/05/2013] [Accepted: 01/24/2014] [Indexed: 01/25/2023]
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Bourguignon C, Labyak SE, Taibi D. Investigating sleep disturbances in adults with rheumatoid arthritis. Holist Nurs Pract 2003; 17:241-9. [PMID: 14596374 DOI: 10.1097/00004650-200309000-00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by inflammation and joint involvement. Most adults with RA experience sleep disturbances, including longer times before falling asleep, numerous awakenings during the night, and early morning wakening, resulting in excessive daytime sleepiness and fatigue. This article will review what is known about sleep disturbances and the biologic basis in adults with RA, the influence of ovarian hormone levels in women with RA, how medications may influence sleep in RA, and complementary and alternative therapies that may be useful in reducing sleep disturbances.
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Affiliation(s)
- Cheryl Bourguignon
- Center for the Study of Complementary & Alternative Therapies, School of Nursing, University of Virginia, Charlottesville, Va 22908, USA.
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Abstract
Evidence for the reciprocal role of the immune system in sleep is growing. Sleep disturbances are believed to be both a cause and a consequence of various immune and autoimmune conditions.
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Affiliation(s)
- Felissa R Lashley
- College of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07102, USA.
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Abstract
Wake/sleep complaints are very common in the rheumatic diseases, and include: insomnia, non-restorative sleep, frequent awakenings, daytime fatigue and excessive daytime sleepiness. Imprecise use of terminology has confused 'sleep dissatisfaction' (i.e. 'non-restorative sleep') with specific sleep disorders (i.e. 'insomnia' or 'sleep fragmentation') and 'fatigue' with 'daytime sleepiness'. This review examines current concepts from the literature of disparate disciplines pertaining to the complaint of poor sleep and daytime fatigue in patients with rheumatic disorders. The ability to monitor multiple physiologic parameters during sleep (polysomnography) has led to a greater understanding of normal and abnormal phenomena which occur during sleep, and has resulted in the identification of a variety of sleep disorders which have specific therapeutic implications. Actigraphy allows the prolonged monitoring of wake/sleep patterns, and the multiple sleep latency test permits the determination of physiologic sleepiness during the daytime. These techniques enable identification of objective sleep disorders in those whose complaint is subjective sleep dissatisfaction, and permit differentiation between the easily confused complaints of excessive daytime sleepiness and fatigue. The abnormal sleep/wake symptoms in patients with rheumatic diseases may not simply be a 'non-specific' or systemic effect of the disease. Some patients may have a specific sleep disorder (either independent from, or due to, the underlying rheumatic condition) which should be diagnosed and treated specifically. Conversely, subjective 'sleep dissatisfaction' does not necessarily imply an underlying sleep disorder. The primary intent of this review is to encourage systematic, objective study of sleep and daytime function in these common, often disabling conditions.
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