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Identifying comorbid obstructive sleep apnea in chronic musculoskeletal pain: A systematic review

Julya Perea¹, Julia Kortstee¹, Zosia Goossens²

¹Federal University of São Carlos, Department of Physiotherapy, São Carlos, São Paulo, Brazil; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.

The Journal of Pain

|February 27, 2025

Abstract:

Obstructive sleep apnea (OSA) is common in patients with chronic musculoskeletal pain (CMP). Understanding the characteristics of the CMP population with comorbid OSA is important for proper screening and management. This systematic review compiles evidence on methods used to identify OSA in patients with CMP and identifies the characteristic features of patients with CMP and comorbid OSA. A systematic search was conducted in Medline (PubMed), Embase and Web of Science. Broad search terms related to sleep apnea and CMP were used. Studies had to include individuals with CMP diagnosed with OSA or individuals with CMP in whom OSA symptoms were assessed as outcomes. The protocol was pre-registered on PROSPERO (CRD42024516140). The initial search identified 3832 records, and 30 studies (total n=7085 participants) were included. Laboratory sleep polysomnography was the most used objective assessment method, while the Berlin and STOP-BANG questionnaires were the most used self-report instruments. However, these questionnaires showed poor agreement with polysomnography. The results consistently showed that fatigue and pain distribution did not differ between CMP patients with and without OSA. Inconsistent results were found regarding higher age, higher body mass index, psychological factors, decreased sleep quality, increased sleepiness, and pain intensity as characteristic features of the CMP with OSA population compared to the CMP without OSA. No factors consistently characterized the CMP with OSA population. Further research is required to explore the factors that consistently characterize patients with CMP with comorbid OSA to improve the effectiveness of screening for OSA in daily practice. PERSPECTIVE: This work summarizes the tools used to assess obstructive sleep apnea in populations with chronic musculoskeletal pain and highlights the features of individuals with both conditions compared to those with only chronic musculoskeletal pain.

Keywords:

Ankylosing spondylitis Fibromyalgia Low back pain OSA Osteoarthritis Rheumatoid arthritis

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