Have Rheumatoid Arthritis and Snore? You Might Have Sleep Apnea

A 2021 review looked at 8 studies examining the medical records of over 37,000 patients. The review confirmed what doctors have suspected for a while now: as many as a third of all people diagnosed with rheumatoid arthritis (RA) may also have obstructive sleep apnea (OSA).¹

The review, thought to be the most comprehensive investigation into the prevalence of OSA in the rheumatic disease population, suggests possible connections linking the 2 conditions.

Rheumatoid arthritis and obstructive sleep apnea

How can a joint condition be linked to a sleep disorder?

Shared risk factors

Several studies examined in the review found OSA to be highly prevalent in people with RA. This was especially true for those with RA damage in the upper cervical spine. This particular expression of RA is a cause of both OSA and central sleep apnea.²

Further explanations for problems with OSA in people with RA include:³

• Other structural differences in the head, neck, and spine – including an underdeveloped lower jaw or degeneration of the temporomandibular joint
• Systemic inflammation, in which higher levels of tumor necrosis factor related to RA may increase one’s odds of developing OSA
• Aside from aging – a common risk factor shared by RA and OSA – a high body mass index (BMI) may be the principal cause for developing sleep apnea when you already have RA

Comorbidities

When someone with RA also has OSA, this can introduce a whole new constellation of health concerns, some of them life-threatening. These fall inside the realm of cardiovascular diseases such as heart attack and stroke. Treating RA with OSA can lead to reduced risks for these and other dangerous conditions like cancer and diabetes.⁴

Get a sleep apnea assessment

The most common shared symptom of both OSA and RA is daytime sleepiness and feelings of fatigue while awake. This is when a chicken-and-egg scenario may develop: Are one’s sleepiness or fatigue the result of flare-ups of RA, or are they caused by underlying OSA that has not been diagnosed or is not being adequately treated?³

If you have been told you snore, and the snoring is loud or persistent, this might be evidence of a sleep disorder. The research team behind the review recommends that people with RA who have sleep-breathing problems seek a referral to a sleep doctor. Their logic is practical and holistic: “Treatment for co-existing OSA in patients with RA may prove beneficial in terms of future cardiovascular and respiratory morbidity, as well as potentially improving measures of inflammation, pain, and fatigue.”²

Be proactive about chronic inflammation

Both RA and OSA are known to cause chronic bouts of inflammation. Managing this requires, at minimum, adequate treatment of both RA and OSA. You can also prevent or reduce chronic inflammation through lifestyle changes. These include:⁴

• Stop smoking. There is a direct link between inflammation and the toxins encountered while smoking.
• Manage cholesterol. High levels of “bad cholesterol” (LDL) can restrict blood flow and lead to inflammation in the arteries.
• Practice good oral hygiene. If your gums bleed every time you floss or brush your teeth, this can signal problems with chronic inflammation.
• Be smart about foods. Some foods promote inflammation in the body, while others can reduce inflammation. Foods to avoid include those high in sugars, processed foods, and refined carbohydrates. Foods that can lower inflammation include antioxidant-rich fruits and vegetables, green tea, and turmeric.
• Be a body in motion. Even just 10 minutes of walking can protect against or reduce chronic inflammation.

Weight loss for pain relief and to prevent OSA

The key link between RA and OSA remains connected to high BMI (being overweight or obese). We already know that high BMI also contributes to the development of sleep apnea even without RA. If you have RA and your BMI measures in the normal range, you would be well-advised to prevent any future development of OSA by simply maintaining a healthy weight.^1,2

However, if you’re carrying a little extra weight, now’s the time to chat with your doctor about ways to shed some pounds as part of your RA and OSA treatment, as both conditions can improve with careful weight loss.

Do you experience RA and OSA? Please share your story or comment below.