Severity of the Apnea-Hypopnea Sleep Syndrome in Patients with Rheumatoid Arthritis and Spondyloarthropathies. Modulation of the Sleep Apnea Index with Anti-TNF-? Inhibitors

Abstract

Objective: To evaluate severity of the sleep apnea-hypopnea syndrome (SAHS) in patients with rheumatoid arthritis (RA) and spondyloarthropathies (SpA). To study the behavior of the apnea-hypopnea index (AHI) in patients treated with anti-TNF-α. Materials and methods: An observational, retrospective study was conducted in patients with RA and SpA (study group) and with osteoarthritis (control group) who have SAHS symptoms. AHI (expressed in median and 25- 75 percentiles), mean oxygen saturation (SaO2 ) and information on associated cardiovascular risk factors (CVRF) were collected. This information was also collected in the anti-TNF-α treated study group. Results: The study group (75 patients [48 with RA and 27 with SpA], 36 men) were younger (53.1 ± 10.6 vs. 57.2 ± 9.6 years, p=0.022) compared to the control group (58 patients, 23 men). The study group had a higher incidence of hypercholesterolemia (62.7% vs. 17.2%, p<0.001) and ischemic heart disease (17.3% vs. 3.4%, p=0.013). Sixteen patients of the study group were treated with anti-TNF-α. Patients in the study group had higher AHI than the control group (median 37.4 vs. 27.8, p=0.025). Those treated had a similar value to the control group (29.1 vs. 27.8, NS) and a lower value compared to the non-treated (29.1 vs. 36.8, p=0.052). No differences in the SaO2 were observed. Conclusions: Patients with SAHS and inflammatory arthritis are younger and have more CV risk factors than those who have non-inflammatory arthropathy. Patients with SAHS and inflammatory arthritis treated with TNF-α inhibitors have a lower AHI than those treated only with disease modifying drugs and one that is similar to patients with non-inflammatory arthropathy. This suggests improvement of the SAHS.