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Sleep apnea and lupus may be connected, although researchers don’t fully understand why. Sleep problems are common in people with lupus, and sleep apnea is one type of sleeping disorder that may affect them. Sleep apnea causes breathing to repeatedly stop and start during sleep.
If you have lupus, sleep apnea, or both, you may notice some similarities between the conditions. This article explores their possible connections and common features.
How Can Lupus Increase the Risk of Sleep Apnea? Some studies suggest that obstructive sleep apnea (OSA) may be more common in people with systemic lupus erythematosus (SLE, or lupus) than in people without SLE. OSA is a common form of sleep apnea in which the airway becomes blocked during sleep. Researchers have also found that people with SLE may have poorer sleep quality.
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However, researchers don’t yet know how strong this connection is. Studies have reported inconsistent results, and many have included only small numbers of participants.
Still, lupus has several features that might raise the risk of sleep apnea, including some that are known OSA risk factors. Here are a few possibilities.
Chronic inflammation is one possible link between OSA and lupus. Lupus can cause inflammation throughout the body, which can damage tissues and organs over time. This ongoing inflammation may contribute to the higher risk of OSA seen in some people with lupus.
OSA can also lead to chronic inflammation. When breathing repeatedly stops or slows during sleep, blood oxygen levels can drop, which can trigger inflammation. Sleep problems and inflammation may also affect the immune system in ways that could be important in autoimmune diseases such as lupus.
Lupus and its treatment can sometimes affect body weight. Lupus symptoms may lead to unintentional weight loss, while corticosteroids commonly used to treat lupus can contribute to weight gain.
Having a higher body weight is a known risk factor for OSA because excess tissue around the neck can narrow or block the airway during sleep. Researchers report that people with obesity (a body mass index of 30 or higher) are about 10 times more likely to have clinically significant OSA than people with a weight in the normal range.
Lupus inflammation can cause inflammation in the kidneys, including a condition called lupus nephritis. Kidney damage can sometimes lead to fluid buildup and swelling.
People with chronic kidney disease have an increased prevalence of both OSA and central sleep apnea (CSA), a type that occurs when the brain doesn’t send the signals needed to breathe normally during sleep. It’s possible that excess fluid may shift toward the neck when a person lies down, which can narrow the upper airway and make breathing harder during sleep.
Other changes linked to advanced kidney disease may also affect how the brain controls breathing or how well breathing muscles work. In turn, OSA may contribute to faster loss of kidney function, suggesting that sleep apnea and kidney disease can affect each other.
Lupus can affect the heart and is associated with an increased risk of heart disease. OSA is also linked to cardiovascular disease, and untreated sleep apnea can increase the risk of serious problems such as heart attack and stroke. Heart failure, which occurs when the heart can’t pump blood as well as it should, is linked to both OSA and CSA.
Lupus and sleep apnea have several overlapping symptoms. Some symptoms related to sleep disturbances, such as fatigue and increased pain, may be mistaken for symptoms of a lupus flare-up.
Fatigue is one of the most common lupus symptoms, affecting around 90 percent of people with lupus. The tiredness can be so intense that it prevents you from working or participating in everyday activities. Other conditions, such as depression and hypothyroidism, can increase fatigue in people with lupus.
Many people with sleep apnea also experience fatigue because of repeatedly disrupted and unsatisfying sleep. Even if you don’t remember waking up throughout the night, the brief awakenings can take a toll on sleep quality and leave you feeling tired during the day.
Lupus can sometimes affect the brain, leading to symptoms such as confusion or brain fog. Depression can also make it hard to concentrate.
Sleep apnea can also make it hard to stay focused during the day. Poor-quality sleep and repeated drops in blood oxygen may contribute to problems with thinking and concentration.
Lupus flare-ups can cause many types of aches and pains, including joint pain, muscle pain, and headaches.
Morning headaches can also be a symptom of sleep apnea. Some people with OSA have recurring headaches when they wake up, sometimes on 15 or more days per month. Researchers are studying whether changes in oxygen and carbon dioxide levels play a role.
Both lupus and sleep apnea are associated with depression, which can cause ongoing hopelessness, sadness, and loss of interest in activities you usually enjoy.
In people with lupus, symptoms of depression are strongly associated with poor sleep quality. Depression and sleep apnea can also share symptoms such as trouble concentrating and fatigue.
People with lupus are about 2.5 times more likely to have poor sleep quality than people with other chronic illnesses, and poor sleep may affect immune function. Unrefreshing, poor-quality sleep is also common with untreated sleep apnea.
When Should You Consider a Sleep Evaluation? It isn’t always easy to tell whether symptoms such as fatigue are related to lupus or a sleep problem. Talk with your healthcare provider about a sleep evaluation if you notice symptoms of sleep apnea, especially:
You may not notice symptoms that happen while you’re asleep. A partner or roommate may be the first to notice loud snoring, gasping, or pauses in your breathing.
A sleep study, also called polysomnography, can help diagnose sleep apnea. During the study, equipment monitors your breathing, blood oxygen levels, brain activity, and heart rate, as well as arm and leg movements, while you sleep.
Treating sleep apnea may help improve symptoms such as daytime sleepiness and trouble concentrating. Getting better sleep may also help prevent lupus flare-ups and improve your quality of life.
Continuous positive airway pressure (CPAP) therapy is a common OSA treatment that uses air pressure to keep your airway open while you sleep. Oral appliances that help keep the airway open may be another option for some people. Be sure to also stay on track with your prescribed lupus treatment.
Your healthcare provider may also recommend lifestyle changes, such as staying physically active, to help improve both sleep apnea and lupus.
On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.
How do you manage sleep apnea and lupus at the same time? Let others know in the comments below.
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