Prevalence of Obstructive Sleep Apnea in Joint Hypermobility Syndrome: A Systematic Review and Meta-Analysis, 2019, Sedky et al.

[nataliezzz]

Prevalence of Obstructive Sleep Apnea in Joint Hypermobility Syndrome: A Systematic Review and Meta-Analysis
Karim Sedky, Thomas Gaisl, David S. Bennett
https://jcsm.aasm.org/doi/10.5664/jcsm.7636 (PDF available)

ABSTRACT

Study Objectives: Because of associated abnormalities affecting connective tissue in various organs including airways, hypermobility syndrome has been associated with high risk for the development sleep apnea. Ehlers-Danlos syndrome (EDS) and Marfan syndrome (MFS) represent the most common hypermobility syndromes; therefore, the purpose of this review was to examine the prevalence of obstructive sleep apnea (OSA) in these populations.

Methods: All publications and poster presentations written in English found through August 2018 that describe the prevalence of sleep apnea among people with EDS or MFS were included.

Results: A total of 13 studies were identified, 7 for EDS and 6 for MFS. A combined random prevalence rate of OSA across both populations was 48.9% (95% confidence interval 38.3–59.6), with a slightly higher rate of 59.7% (39.7–77.0) for MFS versus 39.4% (28.8–51.1) for EDS. However, a high degree of heterogeneity across studies was found in both groups (EDS group: Q = 28.6 and I2 = 79.0; MFS group: Q = 37.1 and I2 = 86.5). When directly compared to the general population, patients with EDS/MFS were on average six times more likely (odds ratio 6.28 [95% confidence interval 3.31–11.93], P < 0.001, Z = 5.61) to have a diagnosis of OSA.

Conclusions: OSA is a previously underestimated EDS/MFS-related complication. The high prevalence of OSA might be the result of bony and soft-tissue abnormalities associated with these hypermobility syndromes. Untreated OSA is thought to worsen cardiovascular complications especially among those with MFS. Further research is needed to better delineate whether the prevalence of OSA is moderated by factors such as sex, body mass index, bony structure, and disorder subtype.

 

[nataliezzz]

I have seen it claimed on this forum that there is no plausible link between hypermobility and chronic fatigue/chronic widespread pain - I disagree. People with more lax connective tissue have more collapsible upper airways and are more likely to have obstructive sleep-disordered breathing.

Leaving aside the question of the connection between obstructive sleep-disordered breathing and ME/CFS specifically, chronic fatigue is a well recognized symptom of obstructive sleep apnea syndrome (OSAS). I think there is also good evidence for a connection between OSA/S and chronic widespread pain (specifically, fibromyalgia): a meta-analysis found a 21% prevalence of fibromyalgia in OSA patients vs. ~2% in the general population (as discussed in the thread, this is probably skewed towards OSAS patients as they are much more likely to be referred for sleep studies than asymptomatic OSA patients)

S4ME link: Fibromyalgia in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis, 2024, He et al.

I've also made a thread for the study referenced in this meta-analysis that "suggested that the effect of the hypermobility syndrome is comparable to a +11 kg/m2 BMI gain in the normal population"

S4ME link: Obstructive sleep apnoea and quality of life in Ehlers-Danlos syndrome: A parallel cohort study, 2017, Gaisl et al.

And for an explanation of how obstructive sleep-disordered breathing could be causing symptoms like chronic fatigue and chronic widespread pain, here are links to the UARS thread and the AI summary of the UARS theory.