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Katz P, Pedro S, Michaud K. Sleep Disorders Among Individuals With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:1250-1260. [PMID: 35997482 DOI: 10.1002/acr.24999] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Self-reported sleep problems are common in rheumatoid arthritis (RA), with potential negative health implications, yet relatively little research has focused on sleep in RA. We examined the prevalence of obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS) symptoms, and short sleep (SS) in a large RA cohort (n = 4,200) and factors associated with each. METHODS Data are from FORWARD, The National Databank for Rheumatic Diseases. Validated screening measures assessed OSA risk and RLS symptoms. SS was based on self-reported average sleep time (<6 hours). The Medical Outcomes Study Sleep Problems Index I measured self-reported sleep quality. Multivariable logistic regression models identified independent predictors of sleep disorders and sleep quality and the independent association of OSA risk, RLS symptoms, and SS with self-reported poor sleep quality. RESULTS Twenty-one percent (n = 899) had OSA diagnosis or risk, 30% (n = 1,272) had RLS symptoms or diagnosis, and 43% (n = 1,737) reported SS, and RA disease activity was associated with each sleep disorder. Abatacept use was associated with lower odds of RLS and SS. Use of conventional disease-modifying antirheumatic drugs or abatacept was less frequent in the SS group. No medications were associated with OSA in multivariable analyses. Both RLS and SS was associated with worse perceived sleep quality. DISCUSSION Almost two-thirds met criteria for at least one sleep disorder. RA disease activity and pain were significantly associated with each sleep condition. Additional research is needed to identify the causal pathway between sleep disorders and RA disease activity and pain and the long-term consequences of sleep disorders in RA.
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Affiliation(s)
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha
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Thakur B, Pathak M, Singh P, Padhan P. Answer to "Obstructive sleep apnea in patients with rheumatoid arthritis: The multidisciplinary approach and multidimensional assessment". Int J Rheum Dis 2023; 26:568-569. [PMID: 36502524 DOI: 10.1111/1756-185x.14535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Bhaskar Thakur
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mona Pathak
- School of Pharmacy, University of North Texas, Fort Worth, Texas, USA
| | - Pratima Singh
- Department of Pulmonary Medicine, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Prasanta Padhan
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
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Wali S, Mustafa M, Manzar D, Bawazir Y, Attar S, Fathaldin O, Bahlas S, Alsolaimani R, Alhejaili F, Abdelaziz M. Prevalence of obstructive sleep apnea in patients with rheumatoid arthritis. J Clin Sleep Med 2020; 16:259-265. [PMID: 31992430 DOI: 10.5664/jcsm.8178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although previous studies suggested an increased prevalence of obstructive sleep apnea (OSA) among patients with rheumatoid arthritis (RA), no existing large prospective study has addressed this association using objective measures. This study aims to assess the prevalence of OSA using polysomnography (PSG) in patients with RA and its relationship with RA activity. METHODS Patients with RA who presented at the rheumatology clinic at a university hospital from 2017 to 2018 were eligible. In the first stage, data from the Disease Activity Score 28, Berlin questionnaire, and Epworth Sleepiness Scale were obtained, along with personal data and a comprehensive medical history. The second stage involved a case-control study confirming OSA with PSG. OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/h, whereas patients with an AHI ≥ 15 events/h were categorized as having moderate-severe OSA. RESULTS In total, 199 patients with RA were recruited, 110 patients (55%) underwent PSG, and 5 were excluded. The mean age was 48.93 ± 12.7 years, and the mean body mass index was 31.70 ± 9.74 kg/m²; 94% were female. In total, 67 participants (33.2%) were at high risk for OSA (36 [55.4%] underwent PSG), whereas 132 (66.8%) were at low risk (69 [51.5%] underwent PSG). The estimated prevalence of OSA (AHI ≥ 5 events/h) in the whole population was 58.1%, whereas the prevalence of moderate-to-severe OSA (AHI ≥ 15) was 22.9%. CONCLUSIONS This prospective PSG-based study demonstrated that OSA is more common in patients with RA than in the general population, but there appears to be no relationship with disease activity.
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Affiliation(s)
- Siraj Wali
- Sleep Medicine Research Group, Sleep Medicine and Research Center, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohammad Mustafa
- Department of Medicine, Rheumatology Unit, University of Jeddah, Jeddah, Saudi Arabia
| | - Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Yasser Bawazir
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Suzan Attar
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Fathaldin
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sami Bahlas
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Roaa Alsolaimani
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faris Alhejaili
- Sleep Medicine Research Group, Sleep Medicine and Research Center, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Daïen CI, Tubery A, Beurai-Weber M, du Cailar G, Picot MC, Jaussent A, Roubille F, Cohen JD, Morel J, Bousquet J, Fesler P, Combe B. Relevance and feasibility of a systematic screening of multimorbidities in patients with chronic inflammatory rheumatic diseases. Joint Bone Spine 2019; 86:49-54. [DOI: 10.1016/j.jbspin.2018.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/15/2018] [Indexed: 12/14/2022]
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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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