A Case of Rheumatoid Arthritis and Obstructive Sleep Apnea (2025)

Sleep Problems in Chronic Inflammatory Diseases: Prevalence, Treatment, and New Perspectives: A Narrative Review

Journal of Clinical Medicine

Epidemiological studies have shown that individuals with sleep problems are at a greater risk of developing immune and chronic inflammatory diseases. As sleep disorders and low sleep quality in the general population are frequent ailments, it seems important to recognize them as serious public health problems. The exact relation between immunity and sleep remains elusive; however, it might be suspected that it is shaped by others stress and alterations of the circadian rhythm (commonly caused by for example shift work). As studies show, drugs used in the therapy of chronic inflammatory diseases, such as steroids or monoclonal antibodies, also influence sleep in more complex ways than those resulting from attenuation of the disease symptoms. Interestingly, the relation between sleep and immunity appears to be bidirectional; that is, sleep may influence the course of immune diseases, such as inflammatory bowel disease. Thus, proper diagnosis and treatment of sleep disorders are vital ...

Frequency of sleep disorders in patients with rheumatoid arthritis

Open Access Rheumatology: Research and Reviews

To determine the prevalence of common sleep problems among patients with rheumatoid arthritis (RA) and their relationship with the disease activity and quality of life. Patients and methods: The study sample consisted of 101 patients who attended a rheumatology clinic at a university hospital between October 2015 and May 2016. All subjects were clinically examined and interviewed by physicians using a questionnaire. The collected information included sociodemographic characteristics, the patients' medical histories, the Disease Activity Score (DAS28), the Berlin questionnaire to assess the risk of obstructive sleep apnea (OSA), the Epworth Sleepiness Scale to assess excessive daytime sleepiness (EDS), the Athens Insomnia Scale to assess insomnia, the International RLS Study Group score to diagnose restless legs syndrome (RLS), and the Health Assessment Questionnaire (HAQ) to assess the quality of life. Results: The mean age of the participants was 48.7±14.6 years, and 95% of the participants were females. Approximately 60% of the participants were in the remission/low category of disease activity, and the average DAS28 score was 3.3±0.8 years. The prevalence rates of insomnia, EDS, sleep disturbance, risk of OSA, and RLS were 63%, 20%, 20%, 37%, and 63%, respectively. Furthermore, the distribution of sleep disorders was not affected by the disease activity. The association between the HAQ and sleep disorders among the RA patients was not significant. Conclusion: Sleep disorders are common among RA patients and may require further attention by treating clinicians; nevertheless, these disorders are not associated with disease activity and do not affect the quality of life.

Treatment management of children with juvenile idiopathic arthritis with temporomandibular joint involvement: a systematic review

Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology, 2014

Objective. This study aimed to systematically review the available literature on the treatment of patients with juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement. Study Design. According to the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, studies were included until August 2012. Results. A total of 40 articles were identified. TMJ involvement in patients with JIA varies between 17% and 87%. The mean age at diagnosis of JIA is 7.2 years. TMJ treatment can be divided into 2 main groups, an arthritis group and a dentofacial deformity group. The main treatment modalities are counseling, pharmaceutical interventions, physiotherapy, orthodontic treatment, surgery, or a combination of the aforementioned therapies. Conclusions. TMJ involvement in patients with JIA has a high incidence. There is no consensus on the treatment of TMJ pathology and dentofacial deformities in patients with JIA, and treatment varies from counseling to surgery. Treatment to improve aesthetics and function and to obtain pain reduction can be effective. However, the articles are heterogeneous, and the level of evidence is low (level IV).

Sleep and rheumatologic disorders

Sleep Medicine Reviews, 2008

Arthritis is the leading cause of chronic illness in the United States. Seventy-two percent of the adults aged 55 years and older with arthritis report sleep difficulties. This review discusses sleep disorders associated with rheumatoid arthritis, juvenile rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, scleroderma, Behcet's disease, seronegative spondyloarthropathies, osteoarthritis, sarcoidosis, and fibromyalgia. We describe the inter-relationship between sleep complaints, disease activity, depression, sleep deprivation, and cytokines. An algorithm for evaluation and treatment of sleep disorders associated with rheumatologic diseases is proposed.

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

Sleep Science

This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.

Obstructive Sleep Apnea Syndrome: An Under -recognized Clinical Entity with Significant Systemic Morbidities

RUHS Journal of Health Science, 2018

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent yet under recognized sleep disorder, characterized by repeated disruptions of breathing during sleep. Not just merely a local phenomenon of upper respiratory tract obstruction, this has many consequences that includes intermittent hypoxia, intermittent hypercapnia, reoxygenation, intra thoracic pressure changes, sympathetic activation, micro-awakenings and sleep fragmentation leading to metabolic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress, hypercoagulation, and neurohumoral changes that causes excessive daytime sleepiness, neurocognitive deterioration, endocrine, metabolic and other systemic effects including poor quality of life. There are increasing evidences to suggest that OSAS is a systemic inflammatory disease. Epidemiological studies have identified OSAS as an independent risk factor in cardiovascular diseases, metabolic syndrome and bronchial asthma. Patho-physiological changes in OSAS are causally linked to the hypertension with increase risk for heart failure, stroke and cardiovascular mortality. In addition, OSAS is associated with several other disorders and comorbidities that may affect almost every organ systems of our body. Despite having many complex systemic consequences, OSAS and its secondary effects are mostly controllable by continuous positive air pressure (CPAP). This disorder largely remains an underestimated clinical entity due to unawareness by both the patient and physician alike. There is need for awareness regarding this entity among all specialties of medicine and surgery as the so called undetected/occult disease if remain untreated may lead to significant systemic morbidities and at times mortality. like micrognathia, retrognathia, high arched palate, macroglossia, nasal polyp, deviated nasal septum, genetic predisposition, familial aggregation, cigarette smoking, menopause, alcohol intake, night time nasal congestion, endocrine abnormalities (hypothyroidism/acromegaly, polycystic ovarian syndrome), Down's syndrome, drugs like benzodiazepines, muscle relaxants, testosterone therapy7'8 etc. Recently bronchial asthma, chronic obstructive pulmonary disease (COPD), metabolic syndrome, certain psychiatric problems etc has also emerged as important risk factors for development of OSAS. Poor control of these disorders has been consistently associated with poor sleep, restlessness, breathlessness and poor quality of life among these patients.

Sleep fragmentation in rheumatoid arthritis

Arthritis & Rheumatism, 1989

Prevalence of clinically probable obstructive sleep apnea in American veterans with chronic musculoskeletal pain

Healthy Aging Research, 2016

Background: Coexistence of obstructive sleep apnea (OSA) and chronic musculoskeletal pain (CMP) is common. Patients experiencing pain have a lower threshold for arousals associated with apnea episodes. Pain treatment with analgesics affects upper airway patency during sleep. Methods: Eighty-one patients with CMP, and 100 without, were evaluated using the Berlin Questionnaire (BQ), which classifies patients as high or low risk for clinically probable OSA. Confounding variables including demographics (age, gender, BMI), medication use (sedatives, hypnotics, antidepressants), and Epworth sleepiness score (ESS) were compared between groups. Results: There was no significant difference in gender, use of sedatives and antidepressants, BMI or ESS between cases and controls. There was, however, a significant difference in use of analgesics, and hypnotics. Patients in the control group were significantly older than cases. There was a significant difference in the proportion of high versus low risk BQ values between cases and controls. Logistic regression was performed while adjusting for covariates, which were significantly different between groups (use of analgesics, hypnotics and age). Cases with high-risk BQ scores were not sleepier than controls with high-risk BQ scores. Conclusions: Patients with CMP have a high prevalence of clinically probable OSA. Sleepiness is not prevalent among patients with probable OSA and CMP. High-risk BQ patients were not sleepier than low risk BQ patients.

Management of Young Patients with Temporomandibular Joint Ankylosis—a Surgical and Anesthetic Challenge

Indian Journal of Surgery, 2016

Temporomandibular joint ankylosis is a unique disease where fracture of the mandibular condyle or any other cause leading to ankylosis of the joint can lead to multiple problems if not detected and treated early. If affected in early years of life, it may cause facial dysmorphism, restricted mouth opening, and difficulty in eating, speech, and sleep. Early surgery and physiotherapy can restore the joint function to a great extent. Anesthetizing a pediatric patient with this disorder is a definite challenge which needs expertise in difficult airway management.

Management of Obstructive Sleep Apnoea- A Review Article

International Journal Of Medical Science And Clinical Invention, 2018

Sleep disordered breathing is a term which includes simple snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA). Simple snoring is a common complaint affecting 45% of adults occasionally and 25% of adults habitually and is a sign of upper airway obstruction. The role of dentistry in sleep disorders is becoming more significant, especially in co-managing patients with simple snoring and mild to moderate OSA. The practicing dental professional has the opportunity to assist patients at a variety of levels, starting with the recognition of a sleep-related disorder, referring patients to a physician for evaluation, and assisting in the management of sleep disorders. Diagnosis of OSA is made on the basis of the history and physical examination and investigations such as polysomnography, limited channel testing, splitnight testing, and oximetry. The American Academy of Sleep Medicine (AAOSM) has recommended oral appliances for use in patients with primary snoring an...