According to one study, as many as 91 percent of people living with the inflammatory disease ankylosing spondylitis (AS) often experience sleep disturbance. One of the most common sleep-related comorbidities is sleep apnea — a sleep disorder in which a person’s breathing stops and starts throughout the night. Researchers have found that those living with AS are at an increased risk of developing obstructive sleep apnea (OSA), the most common type of sleep apnea.

Causes and Risk Factors of Sleep Apnea in Spondylitis

One case study published in the journal Medicine examined a 46-year-old man who had lived with AS for 15 years and had developed sleep apnea-hypopnea syndrome. The researchers wanted to find out if people living with AS may be at a higher risk of having sleep apnea. They believed that some of the symptoms of AS also affected the mechanisms that control and allow for normal breathing.

Looking at studies of other individuals living with AS, the researchers found that people who had autoimmune diseases such as AS might also be predisposed to airway compression (the collapsing of the airways due to excess pressure). Because AS attacks the joints in the body, it affects the temporomandibular joint (TMJ) located in the jaw, making it difficult to breathe normally while sleeping.

AS that affects the cervical spine can also lead to respiratory difficulties. AS in the spine (which surrounds important nerve pathways) can compress nerve centers in the brain that are responsible for controlling breathing. This compression can lead to central respiratory depression — slowing down breathing to the point that it's difficult to receive enough oxygen. AS might also physically impede breathing by compressing the pharynx (throat) and trachea (airway), limiting the passageways for air to flow in and out of the lungs.

Disease Duration and Sleep Apnea

A study aimed at determining the prevalence of OSA syndrome (OSAS) in 31 individuals living with AS found that 22.6 percent qualified as having the syndrome. The incidence of OSAS was found to correlate with several factors, including a higher mean body mass index (BMI) and longer disease duration.

The study found that people under age 35 had a lower prevalence (6.3 percent) of OSAS compared to those over the age of 35 (40 percent). Similarly, those who had been living with AS longer were more likely to have developed a sleep disorder. Among those who had lived with AS for at least five years, more than 35 percent had developed OSAS. Among those who’d had AS for less than five years, 11.8 percent had OSAS. The study concluded that a person over 35 who has had AS for at least five years has an increased risk of developing OSAS.

Risk Factors for Obstructive Sleep Apnea in Ankylosing Spondylitis

A study published in Frontiers in Medicine similarly reported that people diagnosed with AS faced an increased risk of developing OSA following their diagnosis. This much larger study (2,210 individuals with AS and 8,840 healthy control participants) found that other risk factors for OSA in AS included:

• Having asthma
• Being male
• Having the virus hepatitis B
• Having esophageal disease

Living With Sleep Apnea and Ankylosing Spondylitis

MySpondylitisTeam members have shared their experiences with sleep apnea. One member wrote about uncovering the reason for their poor sleep: “Finally received an answer regarding another contributing factor to my lack of sleep and fatigue. I was referred to a sleep study, and found out I have severe sleep apnea.”

For some, this sleep disorder presents an added challenge on top of spondylitis and its symptoms. “I’m feeling somewhat depressed right now,” admitted one member. “Found that I not only have sleep apnea, but I also have low oxygen levels, as well. I’m so tired of all these medical issues. I’d be happy if I just had spondylitis and nothing else!”

Research on sleep disturbances in spondylitis has noted that losing sleep can:

• Affect a person’s cognition (thinking and memory)
• Affect their mood (often contributing to depression and anxiety)
• Lead to excessive daytime sleepiness
• Worsen their spondylitis symptoms

Sleep Apnea and Fatigue

According to a study from the Annals of the Rheumatic Diseases, sleep apnea syndrome (SAS) is a major contributor to fatigue in AS, particularly in middle-aged individuals. The study notes that SAS has been found to correlate with increased AS-related health problems (morbidity) and death, which was attributed to the higher incidence of cardiovascular disease linked to SAS.

Managing Sleep Apnea With Ankylosing Spondylitis

There are several ways that you can work with your doctor to manage your sleep apnea while living with AS. Your rheumatologist might refer you for a sleep study, known as a polysomnography, to help uncover the cause of your sleep problems if you have not yet been diagnosed with sleep apnea.

In milder cases, a health care provider may only recommend that you make some healthy changes to your daily habits, such as quitting smoking or losing weight (having a higher BMI may increase your risk of developing sleep apnea). If lifestyle changes are not enough to manage the symptoms of sleep apnea, a doctor may recommend other therapies to improve sleep efficiency.

Talk to your rheumatology specialist or health care provider about ways to treat and manage sleep apnea. Managing this sleep disorder can contribute to better sleep quality, which can, in turn, have positive impacts on your quality of life and overall well-being.

Treating Spondylitis

As the Mayo Clinic notes, treating the underlying spondylitis causing your sleep apnea may help improve the sleep disorder. Talk to your doctor about what treatment options may help you manage the symptoms of AS and slow disease progression.

Airway Pressure Devices

One commonly prescribed therapy for sleep apnea and OSA is continuous positive airway pressure (CPAP). As its name suggests, a CPAP machine delivers positive pressure to the airways, helping to keep them open and prevent obstructed breathing during the night. Another type of airway pressure device that your doctor may prescribe is known as a bilevel positive airway pressure machine.

Several MySpondylitisTeam members have shared their experiences using CPAP machines. As one member wrote, “Today was a good day for me. I started using my CPAP (for my sleep apnea) and felt rested.”

Another member shared that they had been diagnosed with sleep apnea and started to uses a CPAP machine. “Getting used to it,” they wrote. “Feel a little less tired during the day. My hip pain still wakes me every two hours. But still loving life, staying positive!”

Surgery for Sleep Apnea

If your sleep apnea results from spondylitis-related problems involving your TMJ or airway passages, your health care provider may recommend surgery. Surgical procedures are considered a last-resort option and are usually only recommended if other therapies have not worked for three months or longer.

Meet Your Team

MySpondylitisTeam is the social network for people with spondylitis. Here, more than 85,000 members from around the world come together to ask questions, offer support and advice, and connect with others who understand life with spondylitis. Members often discuss conditions that can come alongside spondylitis, including sleep apnea.

Have you dealt with sleep apnea? How have you managed it? Share your thoughts and tips in the comments below or by posting on MySpondylitisTeam.