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Spine (Phila Pa 1976). 2010 Sep 1;35(19):E971-5. doi: 10.1097/BRS.0b013e3181c691df.

Occipitocervical fusion has potential to improve sleep apnea in patients with rheumatoid arthritis and upper cervical lesions.

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  • 1Department of Orthopaedic Surgery, Matsudo City Hospital, Department of Anesthesiology, Chiba University Graduate School of Medicine, Chiba, Japan.

Abstract

STUDY DESIGN:

Case series.

OBJECTIVE:

To analyze factors that contribute to the development of sleep apnea in patients with rheumatoid arthritis (RA) and upper cervical lesions.

SUMMARY OF BACKGROUND DATA:

No large prospective study has analyzed the association between sleep apnea and upper cervical involvement resulting from RA. Furthermore, only 1 report in the literature describes a case of sleep apnea accompanying rheumatoid vertical subluxation of the odontoid process.

METHODS:

The authors analyzed 8 consecutive RA patients with upper cervical lesions who underwent occipitocervical (O-C) fusion. The patients were examined with all-night polysomnography before and after surgery. Patients with apnea-hypopnea index values>or=5 were diagnosed to have sleep apnea. O-C2 angles were calculated from cervical radiographs.

RESULTS:

All 8 patients were diagnosed as having sleep apnea, and most of their apneic episodes were obstructive in origin. Among the 4 patients with medullary compression, central apneic episodes comprised<or=5% of their respiratory events. Two patients with severe sleep apnea had negative O-C2 angles. Six patients who showed postoperative improvements in their sleep apnea all had positive changes in their O-C2 angles exceeding 5 degrees after surgery. The differences between preoperative and postoperative O-C2 angles were significantly greater in the patients with improvement of sleep apnea than in the patients with worsening sleep apnea.

CONCLUSION:

All our study patients with RA and upper cervical lesions had obstructive-dominant sleep apnea. Negative O-C2 angles may result in upper airway narrowing, increasing the severity of sleep apnea. O-C fusion with correction of kyphosis at the craniovertebral junction has the potential to improve sleep apnea in RA patients.

PMID:
20436381
[PubMed - indexed for MEDLINE]
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