Prevalence of obstructive sleep apnea among patients with rheumatoid arthritis and its association with age and body mass index: A systematic review and meta-analysis

Aim: The study aims to recognize the prevalence and possible risk factors of obstructive sleep apnea among individuals with rheumatoid arthritis (RA). Methods: We searched PubMed, Scopus, EMBASE, and Google scholar for potential studies published before the October 30, 2020. The study characteristics, obstructive sleep apnea (OSA) events, and various types of rheumatic diseases were extracted, and the meta-analysis method was used to pool the estimates. Results: We identified eight studies with 37 285 patients for this meta-analysis. The overall pooled prevalence of OSA was 29.8% (95% confidence interval [CI] 15.2-46.7; I² = 99.6%) in the patients with RA. Age was higher in RA patients with OSA but this was not significant. Body mass index (BMI) was significantly associated with OSA in the RA population (standardized mean difference 1.08; P = 0.044). Assessment based on the Berlin Questionnaire^© for Sleep Apnea resulted in a more precise estimate of OSA prevalence with reduced heterogeneity (prevalence 45.3%; 95% CI 37.4-53.3; I² = 58.8%). Conclusion: Prevalence of OSA among the RA cohort was 29.8% with significant heterogeneity. However, the prevalence was 45.3% when studies were restricted to the OSA diagnosis based on the Berlin questionnaire with very low heterogeneity. Higher BMI is the principal risk factor of OSA development in RA. Hence, controlling BMI could be a preventive strategy for OSA among RA patients.