Session Information
Date: Monday, November 9, 2015
Title: Spondylarthropathies and Psoriatic Arthritis - Comorbidities and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Fatigue improves with TNF-inhibition (TNF-i) in people with inflammatory arthritis (IA), but the mechanistic relationships between TNF-i and fatigue are not well understood. Since Obstructive Sleep Apnea (OSA) is a common cause of fatigue in IA patients and TNF-i alters inflammatory pathways that contribute to both IA and OSA, we hypothesized that TNF-i would improve fatigue by altering OSA. Our aim was to explore the relationship between TNF-i, OSA, and fatigue in IA patients.
Methods: Consecutive rheumatology clinic patients who anticipated starting a TNF-inhibitor for IA were screened for OSA with the STOP-Bang questionnaire. Participants with positive screens completed questionnaires and a 2-night ApneaLink home sleep study, before TNF-i and again 2 to 3 weeks after their first dose. Sleep studies were analyzed by both an automated ApneaLink scoring system and a sleep specialist. OSA parameters and fatigue were compared before and after initiation of TNF-i, with adjustment for change in arthritis severity (patient global assessment of arthritis). OSA was assessed with the Apnea Hypopnea Index (AHI) and percent time below 90% oxygen saturation (%time<90%). Fatigue was measured with the Functional Severity Scale (FSS) and Functional Outcome of Sleep Questionnaire (FOSQ).
Results: Eighteen participants completed the pre- and post-TNF-i sleep studies and questionnaires. The mean age was 54 years and 72% were male (Table 1). TNF-i was not associated with improvements in AHI or %time<90%, after adjustment for change in arthritis severity (Table 2). There were non-significant improvements in fatigue.
Conclusion: OSA parameters did not improve within 2-3 weeks of initiating TNF-i, suggesting that fatigue improvements were not driven by OSA changes. The limitations of this proof of concept study include the small sample size and the short time of TNF-i. Additional research is required to understand how TNF-i influences fatigue in IA patients.
Table 1: Baseline demographics and disease characteristics
|
Variables |
Number or Mean (% or SD) |
|
Male |
13 (72.2) |
|
Age |
54.4 ± 14.5 |
|
Body Mass Index |
30.6 ± 7.1 |
|
Inflammatory Arthritis Subtype |
|
|
Axial spondyloarthritis |
4 (22.2) |
|
Psoriatic Arthritis |
10 (55.6) |
|
Rheumatoid Arthritis |
3 (16.7) |
|
Enteropathic Arthritis |
1 (5.6) |
|
Alcohol Use |
4 (22.2) |
|
Sleep Medication Use* |
6 (33.3) |
|
TNF-inhibitor |
|
|
Etanercept |
4 (22.2) |
|
Adalimumab |
10 (55.6) |
|
Infliximab |
4 (22.2) |
*Sleep medications included trazodone, zolpidem, melatonin, alprazolam
Table 2: Obstructive sleep apnea parameters & fatigue before & after initiation of TNF-inhibition
|
|
Before TNF-i (Mean ± SD) |
2-3 weeks after TNF-i (Mean ± SD) |
Unadjusted p value |
Adjusted p value* |
|
AHI |
12.5 ± 8.5 |
13.1 ± 10.3 |
0.18 |
0.97 |
|
% time<90% |
29.5 ± 30.2 |
35.4 ± 36.3 |
0.22 |
0.18 |
|
FSS** |
43.1 ± 15.6 |
41.3 ± 13.5 |
0.40 |
0.08 |
|
FOSQ*** |
11.4± 3.8 |
11.8 ± 3.5 |
0.79 |
0.09 |
*Adjusted for change in patient global assessment of arthritis severity
**FSS= Fatigue Severity Scale: Higher values represent increased fatigue
***FOSQ = Functional Outcome of Sleep Questionnaire: Higher values represent decreased fatigue
To cite this abstract in AMA style:
Breviu B, Braaten T, Clegg D, Walsh J. Obstructive Sleep Apnea and Fatigue in Inflammatory Arthritis Patients Taking TNF-Inhibitors [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/obstructive-sleep-apnea-and-fatigue-in-inflammatory-arthritis-patients-taking-tnf-inhibitors/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/obstructive-sleep-apnea-and-fatigue-in-inflammatory-arthritis-patients-taking-tnf-inhibitors/