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An introduction to the issue of sleep apnea disorder and the issue of snoring

  1. Avoid sleeping on your back which makes it more likely for your tongue and soft tissues to obstruct your airway. In this article, we review risk factors for OSA and prevalence data from a rheumatological perspective.
  2. In face of this challenge, the dentist starts to understand his role in the treatment of snoring and of obstructive sleep apnea and hypopnea.
  3. From the PSG data, it was observed that two male patients met sleep apnoea criteria despite the absence of recognizable OSA symptoms.
  4. See a doctor immediately if you suspect sleep apnea Sleep apnea can be a potentially serious disorder, so contact a doctor immediately if you spot the warning signs.
  5. Also at risk are patients with characteristics specifically related to rheumatic disease sequelae.

Advanced Search Abstract Sleep problems are common concerns in rheumatology patients and have been independently linked to increased pain perception and fatigue severity. Evidence supports an increased prevalence of primary sleep disorders, including sleep apnoea, in some rheumatic disease populations, particularly RA. Obstructive sleep apnoea is a significant public health concern and contributes to increased cardiovascular morbidity and mortality. Patients with obstructive sleep apnoea have also been found to have elevations in circulating acute-phase markers and pro-inflammatory cytokines.

Co-existence of sleep apnoea in rheumatic disease patients may influence the severity of reported symptoms of pain and fatigue, accelerate the risk of cardiovascular events and possibly influence levels of circulating inflammatory markers and mediators.

  1. What is sleep apnea? Is sleep apnoea seen in rheumatic disease patients?
  2. Questionnaire screening identified 24. Tighten the muscles that keep the mouth closed.
  3. How is sleep apnoea diagnosed? Alternative remedies Singing can increase muscle control in the throat and soft palate, reducing snoring and sleep apnea caused by lax muscles.
  4. Of the sleep disorders that may affect rheumatic disease patients, OSA is perhaps the most widely recognized. These differences may contribute to underestimation of OSA in women.
  5. A commonly used tool is the Berlin Questionnaire, which is a three-part instrument that categorizes respondents into the dichotomous choices of high or low risk for sleep apnoea [ 20 ]. Advanced Search Abstract Sleep problems are common concerns in rheumatology patients and have been independently linked to increased pain perception and fatigue severity.

In this article we review the risk factors, prevalence and impact of sleep apnoea from a rheumatological perspective. Additionally, we recommend considering sleep apnoea screening in patients with rheumatic disease and, when appropriate, referral to a specialized sleep disorders clinic. Sleep difficulties may be viewed in many rheumatology patients as a secondary phenomenon related to their rheumatic disease but impairment of sleep has been independently linked with both increased pain perception and reported fatigue severity [ 4—6 ].

Sleep dysfunction has been observed to have a negative impact on quality-of-life measures in RA and OA patients [ 7 ]. Sleep disturbances vary from clinically recognizable distinct sleep disorders to diminished sleep quality, sleep fragmentation and insomnia.

Because specific therapeutic interventions are available for primary sleep disorders, identification of such a distinct diagnosis is clinically important. Less well-defined sleep dysfunction and insomnias may also benefit from a review of sleep hygiene and related issues [ 78 ]. Among the primary sleep disorders are included the different forms of sleep apnoea. Sleep apnoea may be broadly categorized as either i central, which is relatively uncommon, or ii obstructive in aetiology.

Obstructive sleep apnoea OSA is increasingly recognized to be a significant public health issue [ 9 ]. Rheumatologists could have the best opportunity to identify such a concurrent disease within their patient populations. The co-existence of sleep apnoea in rheumatic disease patients may influence the severity of patient-reported symptoms of pain and fatigue, as well as potentially impacting on levels of circulating inflammatory markers and mediators [ 1011 ].

The presence of sleep apnoea as a comorbidity may interfere with the evaluation of rheumatic disease activity and responsiveness to therapy. In this article, we review risk factors for OSA and prevalence data from a rheumatological perspective.

Of the sleep disorders that may affect rheumatic disease patients, OSA is perhaps the most widely recognized. OSA is a specific sleep disturbance that is characterized by recurring apnoeas cessation of airflow for 10 s or longer or hypopnoeas during sleep. OSA is defined by the American Academy of Sleep Medicine as repetitive episodes of upper airway obstruction occurring during sleep and usually associated with a reduction in oxygen saturation [ 13 ].

When accompanied by excessive daytime somnolence or fatigue, the term OSA syndrome may be used. Clinical features associated with OSA, particularly in men, include a history of apnoeic pauses during sleep as well as frequent and loud snoring [ 14 ]. The underlying pathophysiology of OSA involves partial or complete collapse of the posterior oropharynx during sleep. How is sleep apnoea diagnosed?

A diagnosis of sleep apnoea can be indicated by symptomatology and the presence of known risk factors. The gold standard for diagnosis is the overnight polysomnogram PSG. When a PSG is scored, the total number of apnoeas and hypopnoeas is added and then divided by the recorded total sleep time. This ratio is the apnoea—hypopnoea index AHI. Accessibility and cost of PSG is a concern in many areas and may limit test utilization. Alternative diagnostic tools are available and include type III portable monitoring, which has the merits of being less expensive, more convenient for the patient because it can be performed in their own home and validated for use in the diagnosis of OSA [ 19 ].

Screening questionnaires are also available. A commonly used tool is the Berlin Questionnaire, which is a three-part instrument that categorizes respondents an introduction to the issue of sleep apnea disorder and the issue of snoring the dichotomous choices of high or low risk for sleep apnoea [ 20 ]. STOP is an acronym for snoring, tiredness, obstructive apnoeas and blood pressure. The STOP questionnaire was originally developed and validated for surgical patients in pre-operative clinics [ 22 ] but has subsequently been used and validated in broader community settings [ 23 ].

Sleep Apnea

The Epworth Sleepiness Scale ESSwhich is used to evaluate hypersomnolence or excessive daytime sleepiness, is frequently used in the assessment of sleep disorders [ 24 ]. The ESS is a widely administered questionnaire for sleepiness and consists of eight items that evaluate daytime somnolence.

What is the prevalence of sleep apnoea? A combination of both Berlin Questionnaire screening and overnight PSG was used in a recent Norwegian general population study with more than 16 000 participants [ 29 ]. Questionnaire screening identified 24. There has been increasing recognition that OSA in women may differ symptomatically [ 3031 ].

These differences may contribute to underestimation of OSA in women. As many rheumatological disorders affect a higher proportion of women than men, this concern may be relevant for clinical rheumatologists. Is sleep apnoea seen in rheumatic disease patients?

Sleep apnoea and risk for sleep apnoea have been observed in rheumatic disease patients. This has been most frequently reported in the RA population. Objective documentation of sleep apnoea by PSG has been noted in several small series.

In a 1989 report, Mahowald et al. Study participants included 16 RA patients with active disease and problems with onset of fatigue within 6 h after arising. From the PSG data, it was observed that two male patients met sleep apnoea criteria despite the absence of recognizable OSA symptoms.

It was observed that these patients tended to be older, with a mean age of 66 years, in contrast to the total group mean age of 55. In a study evaluating objective and subjective sleep disturbances, Hirsch et al. However, predisposing factors such as TMJ pathology, micrognathia or cervical myelopathy were excluded in the study population. Additionally, the participants were predominantly female and relatively young, with a mean age of 47. Other rheumatic disease groups have also been investigated objectively by PSG.

In that study, 22. It was observed that the frequency of OSA was 6. This selection process resulted in 13 of 25 men and 4 of 92 women being included in the PSG study, of an introduction to the issue of sleep apnea disorder and the issue of snoring 11 84. Sleep-disordered breathing has been reported in children with JIA.

In a larger population, Reading et al. In a mixed general rheumatology clinic population, again using the Berlin instrument, 35. These reports indicate a substantial proportion of patients with rheumatic disorders have co-existing sleep apnoea or are at high risk for sleep apnoea, as per these screening tools.

A clinical association of gout with sleep apnoea has also been observed. Abrams [ 42 ] has elaborated on pathogenic mechanisms in sleep apnoea that may contribute to hyperuricaemia and gout.

With uric acid excretion dependent on renal function, it is interesting that Ahmed et al.

  • However, unlike obstructive sleep apnea, central sleep apnea is often associated with serious illness, such as heart disease, stroke, neurological disease, or spinal or brainstem injury;
  • As many rheumatological disorders affect a higher proportion of women than men, this concern may be relevant for clinical rheumatologists;
  • But loud snoring—especially when accompanied by daytime fatigue—may be a sign of sleep apnea, a common disorder in which breathing repeatedly stops and starts as you sleep;
  • Advanced Search Abstract Sleep problems are common concerns in rheumatology patients and have been independently linked to increased pain perception and fatigue severity;
  • The authors conclude that insufficient sleep quantity may exacerbate pain through elevations of IL-6 [ 55 ];
  • Open your nasal passages at night by using a nasal dilator, saline spray, breathing strips, or a nasal irrigation system neti pot.

Why should rheumatic disease patients be at risk for sleep apnoea? The concept of increased prevalence of OSA in rheumatic disease patients is consistent with understood pathophysiological principles. Rheumatic disease patient subsets at particular risk for OSA include those with general risk factors such as increasing age, BMI and neck circumference [ 14 ]. Also at risk are patients with characteristics specifically related to rheumatic disease sequelae.

Such features include mandibular retrognathia, micrognathiaTMJ or cricoarytenoid joint pathology [ 44—47 ]. In such cases, a direct mechanical influence on airway closure is implicated. Redlund-Johnell [ 46 ] reported 30 of 400 RA patients as having upper airway obstruction episodes, with a relationship to the extent of arthritic destruction of the TMJs.

Sleep Related Breathing Disorders

Earlier reports highlight the role of cricoarytenoid arthritis as a cause of upper airway obstruction [ 47 ]. Cervical spine instability related to RA has also been associated with sleep apnoea. Occipitocervical fusion has been reported by Ataka [ 49 ] to potentially improve sleep apnoea in RA patients with upper cervical lesions. Is there a relationship between inflammation and sleep?

Cytokines have been recognized as playing a role in sleep physiological regulation. This diurnal variation is disturbed in patients with insomnia or sleep deprivation [ 54 ].

Increased levels of inflammatory markers such as CRP and pro-inflammatory cytokines have been observed in sleep-deprived normal volunteers and both adults and children with OSA or sleep-disordered breathing [ 55—58 ]. In one randomized, 16-day, controlled, in-laboratory study of the effect of sleep restriction on 18 healthy volunteers, inflammatory markers and pain scores were measured at baseline and during the study.

In that study, elevated IL-6 levels were strongly associated with increased pain scores in response to sleep restriction. The authors conclude that insufficient sleep quantity may exacerbate pain through elevations of IL-6 [ 55 ]. In another sleep deprivation study, Irwin et al. The authors concluded that sleep loss induces a functional alteration of the monocyte pro-inflammatory cytokine response. Hypothesizing that OSA may be associated with this genetic polymorphism, Riha et al.