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Arthritis, Anxiety and Apnea Connections

Fully 1/3 of people with arthritis were found to have symptoms of  anxiety or depression in this study. Overall, 31% of participants with arthritis had anxiety, and 18% had depression. The authors explain that people living with arthritis may be worried about their livelihood or their ability to perform at their job might be stressful.

Here’s another possible explanation: Having obstructive sleep apnea is known to cause systemic inflammation, including inside the joints. A recent study published in Sleep Medicine showed that heavy snorers had double the risk of developing rheumatoid arthritis later in life. Furthermore, poor sleep in general can also worsen rheumatoid arthritis. I’ve even had a handful of patients that stated that their severe rheumatoid arthritis resolved completely after starting CPAP for obstructive sleep apnea. 

Did your arthritis ever improve after starting treatment for obstructive sleep apnea?

Arthritis and Sleep Apnea

Jane Brody from the New York Times just published an article on osteoarthritis and the high rate of knee replacement procedures. There are many effective ways of treating arthritis, but one thing that most doctors never consider when treating this condition is obstructive sleep apnea. A study in 2009 from the Mayo Clinic showed that people with rheumatoid arthritis (RA) had significantly higher risk of having obstructive sleep apnea (50%) compared with those that did not (31%). We know that RA is associated with increased risk of cardiovascular disease, and so is obstructive sleep apnea. The rate of OSA in the elderly is well over 50%. It’s also known that people with arthritis have more sleep problems in general.

Granted this study talks about RA, and not osteoarthritis, but obstructive sleep apnea causes general inflammation throughout the body, and can also involve the body’s joints. Angiogenesis and inflammation are closely associated processes in osteoarthritis. Here’s a review article on osteoarthritis and inflammation.

I’ve had patients that reported significant improvement in arthritis symptoms after treating sleep apnea with CPAP. Even if one does not cause the other, improving sleep in general can help with pain and nighttime arousals.

If you have arthritis and obstructive sleep apnea, did treating obstructive sleep apnea help improve your arthritis symptoms?

Can Sleep Apnea Cause Lupus?

Probably not. But I can make a strong argument that it’s possible with upper airway resistance syndrome.

I saw a patient with UARS today who underwent removal of her large lingual tonsils a few months ago. As expected, her previous poor sleep quality and headaches are much improved, but not completely normal. Opening up the space behind her tongue definitely made a significant difference in how well she breathes at night.

Interestingly, she happened to get tested again for her known lupus condition a few weeks ago, and was excited to tell me that not only that her ANA level come back negative, but many of her other autoimmune markers were significantly improved as well. ANA is a very generic marker for autoimmune disease in general, and not very specific for lupus. However, the improvements in her clinical symptoms, along with changes in her blood tests, strongly suggests that there may be a connection.

Unlike obstructive sleep apnea, patients with upper airway resistance syndrome have overactive immune and nervous systems. Chronic, low-grade physiologic stress that ensues without hypoxia can set up the perfect storm for autoimmune disease development.

Coincidentally, I just had another patient that remarked that his intractable gout improved significantly after eating earlier and using Breathe Rite strips. Another patient had her severe rheumatoid arthritis resolve almost completely after treatment for obstructive sleep apnea.

Casually looking up connections between sleep-breathing disorders and various autoimmune or unusual disorders, I did find a number of small or anecdotal studies.

 

 

 

 

 

 

 

Stay tuned for a future teleseminar on this topic. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phil Mickelson, Arthritis, and Obstructive Sleep Apnea

I've always wondered about a possible link between arthritis and obstructive sleep apnea. We know that people with arthritis also have a higher rate of cardiovascular disease and metabolic syndrome. I recently found out that Phil Mickelson has a debilitating condition called psoriatic arthritis. A few days before the last US Open, he could barely walk. 

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