Abstract
An increased prevalence of obstructive sleep apnoea (OSA) has been suggested in patients with ankylosing spondylitis (AS) in a few controlled studies. We aimed to study the prevalence of OSA compared to controls and to investigate if disease-related and non-disease-related factors were determinants of OSA in AS patients. One hundred and fifty-five patients with AS were included in the Backbone study, a cross-sectional study that investigates severity and comorbidities in AS. Controls were recruited from the Swedish CArdioPulmonary bioImage Study. To evaluate OSA, the participants were asked to undergo home sleep-monitoring during one night’s sleep. For each AS patient 45–70 years old, four controls were matched for sex, age, weight, and height. OSA was defined as an apnoea-hypopnoea index (AHI) ≥ 5 events/hour. Sixty-three patients with AS were examined with home sleep-monitoring, and 179 controls were matched with 46 patients, 45–70 years. Twenty-two out of 46 (47.8%) patients with AS vs. 91/179 (50.8%) controls had OSA (AHI ≥ 5 events/hour), P = 0.72. No differences in the sleep measurements were noted in AS patients vs. controls. In logistic regression analysis adjusted for age and sex, higher age, higher BMI, and lesser chest expansion were associated with the presence of OSA in the 63 AS patients. In the current study, patients with AS did not have a higher prevalence of OSA compared to matched controls. AS patients with OSA had higher BMI, were older, and had lesser chest expansion because of more severe AS compared to patients without OSA.Key points• Patients with ankylosing spondylitis did not have a higher prevalence of obstructive sleep apnoea versus matched controls.• Patients with ankylosing spondylitis and obstructive sleep apnoea were older and had higher body mass index versus patients without obstructive sleep apnoea.• Patients with ankylosing spondylitis and obstructive sleep apnoea had lesser chest expansion versus patients without obstructive sleep apnoea.
Highlights
Ankylosing spondylitis (AS) is associated with an increased risk of several comorbidities [1]
BMI body mass index, ESR erythrocyte sedimentation rate, High-sensitivity C-reactive protein (hsCRP) high-sensitivity C-reactive protein, Bath Ankylosing Disease Spondylitis Activity Index (BASDAI) Bath Ankylosing Disease Activity Index, ASDAS Ankylosing Spondylitis Disease Activity Score, BASMI Bath Ankylosing Spondylitis Metrology Index, BASFI Bath Ankylosing Spondylitis Functional Index, NSAID non-steroidal anti-inflammatory drug, csDMARD conventional synthetic disease modifying anti-rheumatic drug, b biologic, modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) Modified Stroke Ankylosing Spondylitis Score, Epworth sleepiness scale (ESS) Epworth sleeping scale, HDL high-density lipoprotein, LDL low-density lipoprotein analyses adjusted for sex and age revealed that higher BMI, higher age, and lesser chest expansion were determinants for obstructive sleep apnoea (OSA) (Table 4)
We have investigated the prevalence of OSA and other measurements reflecting sleeping patterns assessed by a home sleep-monitoring device in a group of well-characterised patients with ankylosing spondylitis (AS) in comparison with matched controls
Summary
Ankylosing spondylitis (AS) is associated with an increased risk of several comorbidities [1]. Obstructive sleep apnoea (OSA) is related to fatigue, and some small studies have suggested a link between AS and OSA [5, 6]. These studies found OSA to be more frequent in patients with AS compared to the reported prevalence in the general population [7, 8]. Walsh et al reported the comorbidity burden using a large US administrative claims database and found the prevalence of OSA in AS patients to be higher versus controls (8.8% vs 5.1%, P < 0.001) [1].
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