Could Sleep Apnea be a Driver in Chronic Pain?
Date: 04th August 2026 | By: Dr Lourdes Gaspar
Could sleep apnea be an overlooked driver of chronic pain in rheumatology?
A recently published review explores the growing evidence linking obstructive sleep apnoea (OSA) with chronic pain and fatigue across rheumatologic conditions, including rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, axial spondyloarthritis, and fibromyalgia.
Traditionally, persistent pain in these conditions has been attributed primarily to inflammation and disease activity. However, the authors highlight how untreated OSA may act as a significant “symptom amplifier,” contributing to pain through multiple biological pathways. Repeated oxygen deprivation during sleep, sleep fragmentation, oxidative stress, increased inflammatory cytokines, impaired pain inhibition, and central sensitisation may all increase pain perception and fatigue levels.
What makes this particularly important is that many symptoms of OSA, such as fatigue, poor concentration, non-restorative sleep, low mood, and chronic pain, overlap with those commonly experienced by patients with rheumatologic diseases. As a result, sleep apnea may remain undiagnosed while symptom burden continues to be attributed solely to the underlying condition.
The review also examines the potential role of continuous positive airway pressure (CPAP) therapy. While CPAP is already established as the standard treatment for moderate-to-severe OSA, emerging evidence suggests it may also help improve inflammatory markers, fatigue, sleep quality, and pain sensitivity in some patient populations. The direct impact on rheumatology-specific pain outcomes remains less certain, highlighting an important opportunity for future research.
One of the key takeaways is that OSA should not simply be viewed as a respiratory disorder or cardiovascular risk factor. For some patients, it may represent a modifiable contributor to persistent symptoms, particularly when pain and fatigue appear disproportionate to objective measures of disease activity.
As healthcare professionals increasingly embrace holistic and multidisciplinary approaches to care, this review serves as a valuable reminder: when patients continue to struggle despite optimal disease management, it may be worth looking beyond inflammation alone and considering the role of sleep health. The question is no longer whether sleep affects pain. The question may be whether we are routinely looking for the sleep disorders that could be driving it.