Prevalence of clinically probable obstructive sleep apnea in American veterans with chronic musculoskeletal pain

Background: Coexistence of obstructive sleep apnea (OSA) and chronic musculoskeletal pain (CMP) is common. Patients experiencing pain have a lower threshold for arousals associated with apnea episodes. Pain treatment with analgesics affects upper airway patency during sleep. Methods: Eighty-one patients with CMP, and 100 without, were evaluated using the Berlin Questionnaire (BQ), which classifies patients as high or low risk for clinically probable OSA. Confounding variables including demographics (age, gender, BMI), medication use (sedatives, hypnotics, antidepressants), and Epworth sleepiness score (ESS) were compared between groups. Results: There was no significant difference in gender, use of sedatives and antidepressants, BMI or ESS between cases and controls. There was, however, a significant difference in use of analgesics, and hypnotics. Patients in the control group were significantly older than cases. There was a significant difference in the proportion of high versus low risk BQ values between cases and controls. Logistic regression was performed while adjusting for covariates, which were significantly different between groups (use of analgesics, hypnotics and age). Cases with high-risk BQ scores were not sleepier than controls with high-risk BQ scores. Conclusions: Patients with CMP have a high prevalence of clinically probable OSA. Sleepiness is not prevalent among patients with probable OSA and CMP. High-risk BQ patients were not sleepier than low risk BQ patients.