Patients with chronic urticaria may be at risk for obstructive sleep apnea

Patients with chronic urticaria appeared at an increased risk for obstructive sleep apnea, with higher disease activity correlating with greater risk, according to a study published in World Allergy Organization Journal.

Ivan Cherrez-Ojeda, MD, MSc, PhD, of Universidad Espíritu Santo and Respiralab Research Group, both in Ecuador, and colleagues wrote that chronic urticaria can significantly impact a patient’s quality of life, mental health and ability to perform daily tasks.

“These limitations can severely hinder the productivity of [patients with chronic urticaria] at work that, combined with direct health care costs to manage this condition, represents a significant individualized and societal economic burden,” the researchers wrote.

The physical signs and symptoms of chronic urticaria may also affect a patient’s sleep cycle. Patients frequently report difficulty with sleep initiation and nocturnal awakenings.

Considering previously reported connections between chronic urticaria and sleep-related breathing disorders, Cherrez-Ojeda and colleagues conducted a cross-sectional study to determine the frequency of risk categories for undiagnosed obstructive sleep apnea (OSA) among patients with chronic urticaria.

The study comprised 171 Latin American patients (mean age, 41.9 years; standard deviation, 14.4; 68.4% women) diagnosed with chronic urticaria. Based on urticaria control testing, 19.9% had well-controlled chronic urticaria with a mean score of 7.9.

The average chronic urticaria quality-of-life score (on a 0 to 100 scale, 0 being the best and 100 being the worst) was 31.2 and the most frequently affected domains were itching/embarrassment (37.9), sleep (37.2) and mental status (33.7).

Researchers screened patients for OSA with the STOP-Bang questionnaire, which assesses snoring, tiredness during daytime, observed apnea and high blood pressure, as well as BMI of 35 or higher, age of 50 years or older, neck circumference of more than 40 cm and male sex. There are three risk categories: 0 to 2 indicating low risk, 3 to 4 intermediate risk and 5 to 8 high risk.

Results showed an average STOP-Bang score of 2.5, with 24% of patients falling into the intermediate-risk category and 21% into the high-risk category for moderate-to-severe OSA.

Researchers reported a strong statistically significant association between urticaria activity score categories and STOP-Bang risk categories (P = .000) and between UCT and STOP-Bang risk categories (P = .002).

More than half of the patients with moderate-to-severe chronic urticaria had an intermediate to high risk for moderate-to-severe OSA compared with less than 20% of those in the well-controlled or mild groups.

Overall, 72.5% of the cohort reported sleep limitations to a variable degree. Specifically, 67.3% had problems falling sleep, 73.3% reported awakening from sleep and 72.5% felt fatigued during the daytime due to poor sleep quality.

Patients also reported difficulty concentrating (59.1%), which might be linked to reports of affected work productivity (63.2%) and physical activity limitation (59.6%).

“Problems with quality of sleep, even transient sleep loss, can impair cognitive performance and judgement, and lead to an increased risk for other comorbidities including cardiovascular disease,” the researchers wrote.