Split-Night CPAP Therapy for OSA to Improve Joint Immobility

A 47-year-old woman presented to clinic with exertional breathlessness, snoring, choking, witnessed apnoeas and daytime somnolence. Past history included Idiopathic Juvenile Arthritis, diagnosed at age 8, since when she had been taking prednisolone. Her sleep study identified severe Obstructive Sleep Apnoea (OSA). She was commenced on Continuous Positive Airway Pressure (CPAP) therapy, which improved her sleep quality so much that she hardly moved at night and consequently woke up with early morning joint stiffness. She therefore limited her CPAP use and her symptoms persisted. Over time she developed a regime of split-night CPAP use that improved her OSA-related symptoms and joint discomfort.