Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • Kidney Week 2024
    • CHEST 2024
    • ACR Convergence 2023
    • Kidney Week 2023
    • ObesityWeek 2023
    • IDWeek 2023
    • CHEST 2023
    • MDS 2023
    • IAS 2023
    • ACP 2023
    • AAN 2023
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
  • Other Publications
    • www.clevelandclinic.org

User menu

  • Register
  • Log in

Search

  • Advanced search
Cleveland Clinic Journal of Medicine
  • Other Publications
    • www.clevelandclinic.org
  • Register
  • Log in
Cleveland Clinic Journal of Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • Kidney Week 2024
    • CHEST 2024
    • ACR Convergence 2023
    • Kidney Week 2023
    • ObesityWeek 2023
    • IDWeek 2023
    • CHEST 2023
    • MDS 2023
    • IAS 2023
    • ACP 2023
    • AAN 2023
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
From the Editor

Why I, as a rheumatologist, am happy to make the diagnosis of obstructive sleep apnea

Brian F. Mandell, MD, PhD
Cleveland Clinic Journal of Medicine December 2023, 90 (12) 712-713; DOI: https://doi.org/10.3949/ccjm.90b.12023
Brian F. Mandell
Roles: Editor in Chief
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Find this author on Cleveland Clinic
  • Article
  • Info & Metrics
  • PDF
Loading

Embedded Image

In this issue of the Journal, Aboussouan and his multidisciplinary coauthors1 review available treatment options for patients with obstructive sleep apnea (OSA) and discuss the relative benefits. The cardiovascular morbidities associated with OSA are well known. But why should a rheumatologist have special interest in this disorder? The answer lies in 2 major reasons patients are referred for a rheumatology consultation: fatigue and inflammation.

The fatigue part seems obvious. People who don’t sleep well are fatigued, although those with severe OSA, if carefully questioned, describe symptoms of sleepiness instead of or in addition to “fatigue.” Recognizing and implementing effective therapy for OSA will reduce sleepiness and, often, fatigue. While fatigue frequently accompanies inflammation and will likely not abate unless the inflammation is treated, patients with noninflammatory pain may also experience fatigue and sleep disorders. The pain-sleep relationship is complex and bidirectional. Chronic pain can disrupt effective sleep, and patients with disrupted sleep often experience pain and amplified discomfort with various forms of sensory stimulation. Fibromyalgia is the exemplar of the latter.

In addressing fibromyalgia, many of us try to correct the sleep disorder. But this is hard to accomplish. In my experience, behavioral sleep approaches have limited success in these patients, as do pharmacologic efforts to treat the sleep disturbance and pain. Interestingly, OSA seems to be prevalent in patients with fibromyalgia.2 Since OSA has a reasonable chance of responding to treatment, it is worth questioning patients (and their partners) about the symptoms of this disorder and having a low threshold to order a formal sleep study. I have seen benefits in reducing patient symptoms using this approach, and in rare cases, a patient may report resolution of fibromyalgia after successful remediation of their OSA.3

The link between OSA and inflammation is more biologically intriguing but still not well understood, and its clinical significance is not yet clear. Successful treatment of OSA with positive airway pressure has been shown to reduce elevated C-reactive protein levels.4 Patients with OSA have higher serum urate levels, and some studies have indicated they also have a higher likelihood of having gout,5,6 though it is not certain what proportion of this increased risk is attributable to comorbidities in OSA such as obesity and diabetes.7 The authors of a study of 30 patients with moderate-severe OSA suggested that continuous positive airway pressure can elicit a modest reduction in the serum urate level.8 But there have been no large studies on a potential benefit of effective OSA therapy in the management of patients with gout.

Thus, whenever I make the diagnosis of OSA, I also have the possibility of reversing a sleep disorder that may be amplifying a patient’s pain, as well as potentially reducing their systemic inflammation.

As 2023 draws to a close, we at the Journal take this opportunity to thank our peer reviewers and authors who have devoted hours of effort to help us present practical and timely educational articles. We send our sincere wishes for a healthy and hopefully kinder and more peaceful 2024 to them—and to you, our readers.

  • Copyright © 2023 The Cleveland Clinic Foundation. All Rights Reserved.

References

  1. ↵
    1. Aboussouan LS,
    2. Bhat A,
    3. Coy T,
    4. Kominsky A
    . Treatments for obstructive sleep apnea: CPAP and beyond. Cleve Clin J Med 2023; 90(12):755–765. doi:10.3949/ccjm.90a.23032
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Eshak N,
    2. Vutthikraivit W,
    3. Beltagy A,
    4. Pixley J
    . Obstructive sleep apnea in fibromyalgia patients: a meta-analysis [abstract]. Arthritis Rheumatol 2020; 72:(suppl 10). https://acrabstracts.org/abstract/obstructive-sleep-apnea-in-fibromyalgia-patients-a-meta-analysis/. Accessed November 13, 2023.
  3. ↵
    1. Vantine F,
    2. Ettlin D,
    3. Meira-E-Cruz M
    . Resolution of fibromyalgia by controlling obstructive sleep apnea with a mandibular advancement device. Sleep Sci 2021; 14(3):291–295. doi:10.5935/1984-0063.20200077
    OpenUrlCrossRef
  4. ↵
    1. Ishida K,
    2. Kato M,
    3. Kato Y, et al
    . Appropriate use of nasal continuous positive airway pressure decreases elevated C-reactive protein in patients with obstructive sleep apnea. Chest 2009; 136(1):125–129. doi:10.1378/chest.08-1431
    OpenUrlCrossRefPubMed
  5. ↵
    1. Blagojevic-Bucknall M,
    2. Mallen C,
    3. Muller S, et al
    . The risk of gout among patients with sleep apnea: a matched cohort study. Arthritis Rheumatol 2019; 71(1):154–160. doi:10.1002/art.40662
    OpenUrlCrossRef
  6. ↵
    1. Gu X,
    2. Tang D,
    3. Xuan Y,
    4. Shen Y,
    5. Lu LQ
    . Association between obstructive sleep apnea symptoms and gout in US population, a cross-sectional study. Sci Rep 2023; 13(1):10192. doi:10.1038/s41598-023-36755-4
    OpenUrlCrossRef
  7. ↵
    1. Zeng Z,
    2. Jin T,
    3. Ni J, et al
    . Assessing the causal associations of obstructive sleep apnea with serum uric acid levels and gout: a bidirectional two-sample Mendelian randomization study. Semin Arthritis Rheum 2022; 57:152095. doi:10.1016/j.semarthrit.2022.152095
    OpenUrlCrossRef
  8. ↵
    1. Parmaksız E,
    2. Parmaksız ET
    . The effect of CPAP treatment on uric acid levels in obstructive sleep apnea syndrome. Sleep Vigilance 2021; 5:85–88. doi:10.1007/s41782-021-00130-y
    OpenUrlCrossRef
PreviousNext
Back to top

In this issue

Cleveland Clinic Journal of Medicine: 90 (12)
Cleveland Clinic Journal of Medicine
Vol. 90, Issue 12
1 Dec 2023
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Why I, as a rheumatologist, am happy to make the diagnosis of obstructive sleep apnea
(Your Name) has sent you a message from Cleveland Clinic Journal of Medicine
(Your Name) thought you would like to see the Cleveland Clinic Journal of Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Why I, as a rheumatologist, am happy to make the diagnosis of obstructive sleep apnea
Brian F. Mandell
Cleveland Clinic Journal of Medicine Dec 2023, 90 (12) 712-713; DOI: 10.3949/ccjm.90b.12023

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Why I, as a rheumatologist, am happy to make the diagnosis of obstructive sleep apnea
Brian F. Mandell
Cleveland Clinic Journal of Medicine Dec 2023, 90 (12) 712-713; DOI: 10.3949/ccjm.90b.12023
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Linkedin Share Button

Jump to section

  • Article
    • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • The gift of lasting immunity
  • Psychedelics in the medical toolbox?
  • All sulfa drugs are not created equal
Show more From the Editor

Similar Articles

Subjects

  • Pulmonology
  • Rheumatology

Navigate

  • Current Issue
  • Past Issues
  • Supplements
  • Article Type
  • Specialty
  • CME/MOC Articles
  • CME/MOC Calendar
  • Media Kit

Authors & Reviewers

  • Manuscript Submission
  • Authors & Reviewers
  • Subscriptions
  • About CCJM
  • Contact Us
  • Cleveland Clinic Center for Continuing Education
  • Consult QD

Share your suggestions!

Copyright © 2025 The Cleveland Clinic Foundation. All rights reserved. The information provided is for educational purposes only. Use of this website is subject to the website terms of use and privacy policy. 

Powered by HighWire