Sleep Apnea Rate Higher in Patients With Cervical Spondylosis

By Linda Carroll

April 09, 2020

NEW YORK - (Reuters Health) - Cervical spondylosis may nearly double patients' risk for obstructive sleep apnea (OSA), a new study suggests.

Analysis of data from more than 98,000 patients showed OSA was nearly 80% more likely in the presence of cervical spondylosis, researchers reported in Sleep Medicine.

"Cervical spine pathology could give a substantial impact to obstructive sleep apnea occurrence," said lead author Tzong-Hann Yang, chief of the department of otolaryngology-head and neck surgery at Taipei City Hospital in Taiwan.

"In patients with severe sleep apnea, clinicians might need to routinely perform a lateral view of the cervical spine x-ray to evaluate the cephalometry as well as the cervical spine status to see if there is any loss of cervical disc height and thus excessive pharynx mucosa narrowing of the upper airway, or to see if in the bony part of the cervical spine there are protrusions, such as spur formation, osteophyte growth, or other pathologies such as pannus formation in rheumatoid arthritis or diffuse idiopathic skeletal hyperostosis," Yang said in an email.

To see if cervical spine pathology is associated with sleep apnea, Yang and colleagues reviewed data on 98,234 patients who received a first time diagnosis of OSA between 2010 and 2016, plus four propensity-matched controls for each patient.

The prevalence of cervical spondylosis was 18.4% among patients with OSA, significantly greater than the 12.1% rate in controls.

Taking into account factors such as gender, monthly income, geographic location, hyperlipidemia, hypertension, diabetes, coronary heart disease and asthma in a multivariate logistic regression, the researchers found an adjusted odds ratio of 1.778 when comparing those with cervical spondylosis to those without the degenerative condition.

Addressing the spondylosis might lead to improvements in sleep apnea, Yang said.

"Physical therapies such as neck traction are suggested as an adjunctive therapy for obstructive sleep apnea to reduce excessive mucosa crowding into the airway due to loss of cervical disc height," Yang said. "Osteophytes or vertebral spurs might need to be removed if they significantly compromise the space of the upper airway."

"This is a fairly straightforward study that finds an association between two things that I'm not sure are causally related," said Dr. Andrew Varga, an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai. "They try to imply that the fact that someone has degenerative changes in the spine somehow contributes to sleep apnea. But I see no evidence that that is true."

Moreover, Varga said, "the changes at the level of cervical spondylosis are anatomically small and limited to things like inflammation. We know of bigger things that impinge on the airway that don't cause sleep apnea."

Varga also pointed out that the researchers didn't consider obesity in their analysis.

SOURCE: Sleep Medicine, online April 3, 2020.