Pham Tri, Lin Chung-Kuang, Leek Dustin, Chandrashekhar Ravindra, Annaswamy Thiru M
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Sleep Med. 2020 Nov;75:468-476. doi: 10.1016/j.sleep.2020.09.008. Epub 2020 Sep 10.
While obstructive sleep apnea (OSA) is associated with several chronic health conditions such as hypertension, obesity, and chronic hypoxia, there is limited information on its association with neuromuscular and spinal pathologies that may be of interest to a musculoskeletal (MSK) medicine or pain management clinician. The objective of this study was to perform a systematic literature review to examine the association between OSA and cervical spine pathologies, postural changes, and pain.
We systematically reviewed PubMed and Embase databases up to 4/15/2019. We included studies that explored associations between OSA and a) pain, b) postural characteristics or changes, or c) cervical spine morphology. Systematic reviews, meta-analysis, randomized control trials, cohort studies, and case-control studies were included. Case reports, narrative reviews or expert opinion papers were excluded. From the articles that met selection criteria, information regarding type, direction and magnitude of such associations was extracted. The OSA-pain association studies were further divided into 3 subgroups: neuropathic, temporomandibular, and chronic pain.
21 articles that met our study criteria were selected for this review. Two studies were on cervical spine pathologies, eight on postural changes, and eleven on pain associated with OSA. Exploring the association between OSA and cervical spine pathologies, postural changes, and pain in this systematic review we found: (1) Cervical spine lesions, fusions, and abnormalities that reduce retropharyngeal space are associated with OSA, likely by way of worsening posture and decreasing range of motion. (2) Head extension and anteriorization are associated with OSA likely as a compensatory mechanism. Extension may improve airway function, while anteriorization helps to maintain visual sense. (3) Head-of-bed-elevation may improve OSA symptoms and can possibly supplement other conservative treatment measures. (4) Neuropathic pain is associated with OSA, likely by way of inflammatory pathways. (5) Oral appliance use (eg mandibular advancement/protruding device) in OSA likely contributes to transient temporomandibular pain. (6) There is little association between OSA and chronic pain prevalence. (7) Increased pain intensity and decreased pain tolerance are somewhat associated with OSA, likely by way of hypoxemia and sleep fragmentation.
Clinicians in MSK and pain medicine need to consider these associations and consider obtaining imaging studies and/or making referrals for management of their OSA to better provide appropriate care to these patients.
虽然阻塞性睡眠呼吸暂停（OSA）与多种慢性健康状况相关，如高血压、肥胖和慢性缺氧，但关于其与神经肌肉和脊柱病变之间关联的信息有限，而这些关联可能是肌肉骨骼（MSK）医学或疼痛管理临床医生感兴趣的。本研究的目的是进行一项系统的文献综述，以探讨OSA与颈椎病变、姿势变化和疼痛之间的关联。
我们系统检索了截至2019年4月15日的PubMed和Embase数据库。我们纳入了探讨OSA与以下方面之间关联的研究：a）疼痛，b）姿势特征或变化，或c）颈椎形态。纳入了系统评价、荟萃分析、随机对照试验、队列研究和病例对照研究。排除了病例报告、叙述性综述或专家意见论文。从符合入选标准的文章中，提取了有关此类关联的类型、方向和程度的信息。OSA与疼痛关联的研究进一步分为3个亚组：神经性疼痛、颞下颌疼痛和慢性疼痛。
本综述选取了21篇符合我们研究标准的文章。2项研究涉及颈椎病变，8项涉及姿势变化，11项涉及与OSA相关的疼痛。在这项系统综述中，探索OSA与颈椎病变、姿势变化和疼痛之间的关联时，我们发现：（1）颈椎病变、融合以及减少咽后间隙的异常与OSA相关，可能是通过恶化姿势和减小活动范围的方式。（2）头部伸展和前移与OSA相关，可能是作为一种代偿机制。伸展可能改善气道功能，而前移有助于维持视觉感知。（3）抬高床头可能改善OSA症状，并可能补充其他保守治疗措施。（4）神经性疼痛与OSA相关，可能是通过炎症途径。（5）OSA患者使用口腔矫治器（如下颌前移/突出装置）可能导致短暂的颞下颌疼痛。（6）OSA与慢性疼痛患病率之间几乎没有关联。（7）疼痛强度增加和疼痛耐受性降低与OSA有一定关联，可能是通过低氧血症和睡眠片段化的方式。
MSK和疼痛医学领域的临床医生需要考虑这些关联，并考虑进行影像学检查和/或转诊以管理患者的OSA，以便更好地为这些患者提供适当的护理。
