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Ann Rheum Dis 62:183-184 doi:10.1136/ard.62.2.183
  • Letter

Obstructive sleep apnoea as a cause of fatigue in ankylosing spondylitis

  1. N Erb1,
  2. D Karokis1,
  3. J P Delamere1,
  4. M J Cushley2,
  5. G D Kitas1
  1. 1Department of Rheumatology, Dudley Group of Hospitals NHS Trust, UK
  2. 2Department of Respiratory Medicine, Dudley Group of Hospitals NHS Trust, UK
  1. Correspondence to:
    Dr N Erb, Department of Rheumatology, Dudley Group of Hospitals NHS Trust, The Guest Hospital, Tipton Road, Dudley West Midlands DY1 4SE, UK;
    niki{at}erb.org.uk
  • Accepted 7 June 2002

Fatigue is a common symptom in ankylosing spondylitis (AS) occurring in 65% of patients1,2 and forms part of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).3,4 Fatigue has been attributed to sleep disturbance from back pain and stiffness and usually increases with increased disease activity, but can occur independently of AS activity, suggesting the possibility of other causes.1,2 One such cause in the middle aged population is sleep apnoea syndrome (SAS). SAS is defined as 10 or more episodes an hour of airflow interruption for ⩾10 seconds during sleep. It occurs in up to 4% of middle aged people,5 and is associated with increased morbidity and mortality due to higher rates of cardiovascular disease and increased accidents.6,7

We suggest that AS predispose subjects to SAS through several mechanisms, including: restriction of the oropharyngeal airway from temporomandibular joint involvement or cervical spine disease causing pharyngeal and tracheal compression (as has been described in rheumatoid arthritis8); cervical spine disease causing compression …