Background & Aims
Obstructive sleep apnea (OSA) is a prevalent sleep disorder observed in patients with chronic musculoskeletal pain (CMP),1 yet, the association between both is not well understood. Comprehending the factors that characterize the CMP population with comorbid OSA is crucial for effective screening and management, as undiagnosed OSA is associated with cardiovascular and neurological complications.2 This systematic literature review integrates the available evidence in the literature concerning how OSA has been assessed in the CMP population and the characteristics of individuals presenting with CMP and comorbid OSA.
Methods
A systematic literature search was carried out across three databases, Medline (Pubmed), Embase and Web of Science, employing comprehensive search terms related to sleep apnea and chronic pain. Studies had to include individuals with chronic musculoskeletal pain (CMP) diagnosed with obstructive sleep apnea (OSA) or studies including individuals with CMP where OSA symptoms were assessed as outcomes, and not as mandatory inclusion criteria. Exclusion criteria were participants with general chronic pain, cancer-related pain, orofacial pain, and chronic visceral pain. Additionally, other sleep disorders like insomnia, bruxism, or restless legs syndrome were excluded.
Results
The initial search identified 3,832 records, with 30 studies being selected based on inclusion criteria. Polysomnography, conducted in sleep laboratory is considered the objective gold standard test for diagnosing OSA.2 The Berlin and STOP-Bang questionnaires are the most commonly used subjective tools for the assessment of the risk of developing OSA, although it still exhibits a poor agreement with polysomnography.3Among individuals with CMP and OSA versus CMP only, higher age, higher body mass index, depression, anxiety, decreased quality of sleep, and increased sleepiness were found to be inconsistent results to characterize CMP with OSA compared to CMP alone. Evidence regarding differences in pain intensity and pain distribution was found to not characterize CMP with OSA compared to CMP alone. No characteristic factors were found to differentiate the CMP with OSA population compared to CMP alone. 3,4,5
Conclusions
Objective and subjective methods are commonly used to assess obstructive sleep apnea (OSA) in individuals with chronic musculoskeletal pain (CMP). Different factors were identified in the population with CMP and comorbid OSA, but further research is needed to explore the factors that consistently characterize the CMP with OSA population. This is essential to improve the effectiveness of screening for OSA in daily practice.
References
1. Pampati S, Manchikanti L. What Is the Prevalence of Symptomatic Obstructive Sleep Apnea Syndrome in Chronic Spinal Pain Patients? An Assessment of the Correlation of OSAS with Chronic Opioid Therapy, Obesity, and Smoking. Pain Physician. May 2016;19(4):E569-79. PMID: 27228523.
2. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. Mar 15 2017;13(3):479-504. doi:10.5664/jcsm.6506
3. Larsen DB, Bendix L, Abeler K, et al. Obstructive sleep apnea is common in patients with high-impact chronic pain – an exploratory study from an interdisciplinary pain center. Article. Scandinavian Journal of Pain. Jan 27 2022;22(1):106-117. doi:10.1515/sjpain-2021-0112
4. İn E, Turgut T, Gülkesen A, Gündoğdu B. Obstructive sleep apnea syndrome and sleep efficiency in patients with ankylosing spondylitis. Article. Archives of Rheumatology. 2015;30(4):326-333. doi:10.5606/ArchRheumatol.2015.5698
5. Köseoğlu H, İnanır A, Kanbay A, et al. Is There a Link Between Obstructive Sleep Apnea Syndrome and Fibromyalgia Syndrome? Turk Thorac J. Apr 2017;18(2):40-46. doi:10.5152/TurkThoracJ.2017.16036
Presenting Author
Julya Perea
Poster Authors
Julya Perea
Federal University of São Carlos, Department of Physiotherapy, São Carlos, São Paulo, Brazil.
Lead Author
Nils Runge
MSc
Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
Lead Author
Céline Labie
MSc
Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
Lead Author
Zosia Goossens
MSc
Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
Lead Author
Liesbet De Baets
PhD
Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
Lead Author
Jo Nijs
PhD
Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Rheumatology, Arthritis, and Other