AB0152 PROSPECTIVE ANALYSIS OF OBSTRUCTIVE SLEEP APNEA IN NEWLY DIAGNOSED PATIENTS WITH RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS AND PERIPHERAL SPONDYLOARTHRITIS – A SCREENING STUDY
Authors: D. Dejcman, D. Skowasch, C. Pizarro, P. Karakostas, P. Brossart, V. Schäfer
Journal: Annals of the Rheumatic Diseases (2021)

Background: An increased prevalence of obstructive sleep apnea (OSA) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and partially in peripheral spondylarthritis (pSpA) has been noted and described for nearly two decades. Until now, there is no study yet on the occurrence of OSA in patients with these entities at the point of first diagnosis. Identifying and treating OSA could prove pivotal in improving cardiovascular risk and quality of life. Furthermore, clinicians require insights into whom to screen. Objectives: To assess the prevalence of OSA in early RA, PsA and pSpA and strategies for targeted screening. Methods: We performed a prospective study on patients with first diagnosis of RA, PsA or pSpA, who were screened for day sleepiness (assessed by the Epworth sleepiness scale) and tested for obstructive sleep disorders by out-of-center sleep apnea polygraphy (employing Embletta® MPR-PG devices) at the University Hospital of Bonn, Germany. Findings were assessed by three physicians, always including an attending physician responsible for the certified sleep laboratory. Results: A total of 22 patients with RA (52.38%), 15 with PsA (35.7%), and 5 (11.9%) with pSpA were included. Day sleepiness screening was unremarkable (ESS &lt;10) in 29 (69%) patients and suspicious for a sleep disorder (ESS≥10) in 13 patients (31%). Subsequent sleep studies of five patients (11.9%) were suspicious for severe sleep apnea (AHI &gt;15/h), eight (19.1%) for low-to-moderate sleep apnea (AHI 5-15/h) and 29 (69.1%) were unremarkable (AHI &lt;5). Of the eight low-to-moderate results, none were symptomatic as in ESS ≥10, resulting in a total of five (11.9%) guideline-confirming referrals for inpatient polysomnography/ventilation therapy. In comparison with the PsA/pSpA group, a diagnosis of RA had no significant relationship with ESS results (p≈0.23), nor AHI results ≥5/h (p≈0.14). The male cohort yielded more pathological sleep studies, but the result was not significant (16% vs. ~5.9%, p≈0.32). Higher ESS scores (≥10) were not predictive for findings which require a referral (p≈0.37). Increased BMI (≥25 kg/m 2 ) was not associated with an AHI &gt; 5/h (p≈0.63). Conclusion: From the point of screening, a number needed to screen of 8.4 (6.25 in the male, 17 in the female group), speaks in favor of overall cost-efficient screening for OSA in newly diagnosed male patients with arthritis diseases. A different study design, comparing early vs. established arthritis cohorts is necessary to assess the role of disease duration in the possible development of OSA. References: [1]Chung W-S, Lin C-L. Sleep disorders associated with risk of rheumatoid arthritis. Sleep Breath [Internet]. 2018 Dec 10 [cited 2018 Dec 11];22(4):1083–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29428977 . [2]Vakil M, Park S, Broder A. The complex associations between obstructive sleep apnea and auto-immune disorders: A review. Med Hypotheses [Internet]. 2018;110:138–43. Available from: https://doi.org/10.1016/j.mehy.2017.12.004 . [3]Wali S, Mustafa M, Manzar D, Bawazir Y, Attar S, Fathaldin O, et al. Prevalence of obstructive sleep apnea in patients with rheumatoid arthritis. J Clin Sleep Med. 2020. Table 1. Patient characteristics Total (n=42 ) RA (n=22 ) PsA (n=15 ) pSpA (n=5 ) Age Median (IQR) 49 (36-61) 58 (39-64) 43 (30-55) 39 (39-46) Sex Male 25 (59.5%) 15 (68.2%) 6 (40%) 4 (80%) Female 17 (40.5%) 7 (31.8%) 9 (60%) 1 (20%) Obesity by BMI (&lt;25/≥25 ) Normal weight/ Underweight 19 (45.2%) 10 (45.5%) 7 (46.6%) 2 (40%) Overweight/ Obesity 23 (54.8%) 12 (55.5%) 8 (53.3%) 3 (60%) ESS Score &lt;10 29 (69%) 17 (77.3%) 8 (53.3%) 4 (80%) ≥10 13 (31%) 5 (22.7%) 7 (46.7%) 1 (20%) AHI &lt;5/h 29 (69%) 13 (59.1%) 12 (80%) 4 (80%) 5-15/h 8 (19.1%) 6 (27.3%) 1 (6.7%) 1 (20%) &gt;15/h 5 (11.9%) 3 (13.6%) 2 (13.3%) 0 (0%) RA – rheumatoid arthritis, PsA – psoriatic arthritis, pSpA – peripheral spondyloarthritis, IQR – interquartile range, BMI – body mass index, ESS – Epworth Sleepiness Scale, AHI – Apnea/Hypopnea Index Disclosure of Interests: None declared