OSA and Chronic Pain
There is a strong correlation between obesity and chronic pain. One of the mechanisms for this may be reduced pain tolerance due to Obstructive Sleep Apnoea (OSA), with pain and sleep influencing each other in a bidirectional relationship.[1] CPAP therapy not only improves sleep quality but also has beneficial effects on pain outcomes, including pain intensity, threshold, and tolerance, in patients with OSA.
Pathophysiology
Hyperalgesia is a phenomenon observed in patients with OSA. This condition is primarily attributed to the pathophysiological changes associated with OSA, such as nocturnal hypoxemia, sleep fragmentation, and systemic inflammation.
Nocturnal hypoxemia, a hallmark of OSA, leads to increased expression of proinflammatory cytokines, which can prime nociceptors and enhance pain sensitivity.[2] Additionally, chronic intermittent hypoxia (CIH) associated with OSA has been shown to induce hyperalgesic priming through mechanisms involving peripheral macrophage recruitment and inflammatory cytokine release, which sensitize nociceptors.[3]
Sleep fragmentation, another characteristic of OSA, disrupts normal sleep architecture and has been linked to increased pain sensitivity. This disruption can impair the body's natural pain modulation mechanisms, further contributing to hyperalgesia.[4]
Treatment
A systematic review by McCarthy et al. found that CPAP therapy is associated with improved pain outcomes, particularly in reducing headache pain in patients with OSA.[5] Additionally, Shen et al. demonstrated that CPAP treatment significantly decreased pain intensity in patients with moderate-to-severe OSA after three months of therapy.[6]
In obese patients with OSA, Lahaye et al. observed that CPAP therapy partially reverted enhanced pain sensitivity, indicating an increase in pain threshold after one month of treatment.[7] Similarly, Khalid et al. reported that CPAP therapy reduced pain sensitivity in severe OSA patients, as evidenced by increased finger withdrawal latency to a radiant heat stimulus.[8]
Onen et al. conducted a randomized, double-blind crossover study in 13 elderly patients with OSA and found that CPAP treatment significantly improved pain tolerance.[9]
References
- ā Aytekin, Ebru; Demir, Saliha Eroglu; Komut, Ece Akyol; Okur, Sibel Caglar; Burnaz, Ozer; Caglar, Nil Sayiner; Demiryontar, Dilay Yilmaz (2015). "Chronic widespread musculoskeletal pain in patients with obstructive sleep apnea syndrome and the relationship between sleep disorder and pain level, quality of life, and disability". Journal of Physical Therapy Science (in English). 27 (9): 2951ā2954. doi:10.1589/jpts.27.2951. ISSN 0915-5287. PMC 4616133. PMID 26504332.CS1 maint: PMC format (link)
- ā Kaczmarski, Piotr; Karuga, Filip Franciszek; Szmyd, Bartosz; Sochal, Marcin; BiaÅasiewicz, Piotr; Strzelecki, Dominik; Gabryelska, Agata (2022-08-13). "The Role of Inflammation, Hypoxia, and Opioid Receptor Expression in Pain Modulation in Patients Suffering from Obstructive Sleep Apnea". International Journal of Molecular Sciences (in English). 23 (16): 9080. doi:10.3390/ijms23169080. ISSN 1422-0067. PMC 9409023. PMID 36012341.CS1 maint: PMC format (link)
- ā Chivers, Samuel B.; Andrade, Mary Ann; Hammack, Robert J.; Shannonhouse, John; Gomez, Ruben; Zhang, Yan; Nguyen, Brian; Shah, Pankil; Kim, Yu Shin; Toney, Glenn M.; Jeske, Nathaniel A. (2024-07-30). "Peripheral macrophages contribute to nociceptor priming in mice with chronic intermittent hypoxia". Science Signaling (in English). 17 (847): eadn8936. doi:10.1126/scisignal.adn8936. ISSN 1945-0877. PMC 11412124. PMID 39078919.CS1 maint: PMC format (link)
- ā Doufas, Anthony G.; Tian, Lu; Padrez, Kevin A.; Suwanprathes, Puntarica; Cardell, James A.; Maecker, Holden T.; Panousis, Periklis (2013-01-29). Paul, Friedemann (ed.). "Experimental Pain and Opioid Analgesia in Volunteers at High Risk for Obstructive Sleep Apnea". PLoS ONE (in English). 8 (1): e54807. doi:10.1371/journal.pone.0054807. ISSN 1932-6203. PMC 3558510. PMID 23382975.CS1 maint: PMC format (link)
- ā McCarthy, Kristian; Saripella, Aparna; Selvanathan, Janannii; Nagappa, Mahesh; Englesakis, Marina; Wang, David; Peng, Philip; Chung, Frances (2022-03). "Positive airway pressure therapy for chronic pain in patients with obstructive sleep apneaāa systematic review". Sleep and Breathing (in English). 26 (1): 47ā55. doi:10.1007/s11325-021-02363-7. ISSN 1520-9512. Check date values in:
|date=(help) - ā Shen, Chong; Ou, Yanru; Ouyang, Ruoyun; Zong, Dandan (2023-09-21). "Prevalence and characteristics of pain in moderate-to-severe obstructive sleep apnea patients and effect of CPAP treatment". Scientific Reports (in English). 13 (1): 15758. doi:10.1038/s41598-023-42967-5. ISSN 2045-2322. PMC 10514028. PMID 37735494.CS1 maint: PMC format (link)
- ā Lahaye, ClĆ©ment; Miolanne, Magalie; Farigon, Nicolas; Pereira, Bruno; Dubray, Claude; Beudin, Patricia; Greil, Annick; Boirie, Yves (2023-05). "Enhanced pain sensitivity in obese patients with obstructive sleep apnoea syndrome is partially reverted by treatment: An exploratory study". European Journal of Pain (in English). 27 (5): 624ā635. doi:10.1002/ejp.2085. ISSN 1090-3801. Check date values in:
|date=(help) - ā Khalid, Imran; Roehrs, Timothy A.; Hudgel, David W.; Roth, Thomas (2011-12). "Continuous Positive Airway Pressure in Severe Obstructive Sleep Apnea Reduces Pain Sensitivity". Sleep (in English). 34 (12): 1687ā1691. doi:10.5665/sleep.1436. ISSN 0161-8105. PMC 3208846. PMID 22131606. Check date values in:
|date=(help)CS1 maint: PMC format (link) - ā Onen, S.-Hakki; Onen, Fannie; Albrand, Gilles; Decullier, Evelyne; Chapuis, FranƧois; Dubray, Claude (2010-11). "Pain Tolerance and Obstructive Sleep Apnea in the Elderly". Journal of the American Medical Directors Association (in English). 11 (9): 612ā616. doi:10.1016/j.jamda.2010.04.003. Check date values in:
|date=(help)
