Background: Tumor necrosis factor-α (TNF-α) plays a role in the pathogenesis of and serves as a biomarker for obstructive sleep apnea (OSA) [1]. Moreover, patients with juvenile idiopathic arthritis (JIA) had a numerically elevated risk of OSA [2-4]. Given TNF-α inhibitors have been widely used to treat JIA, the aim of the present study was to assess the risk of OSA among patients with JIA on TNF-α inhibitors.
Methods: This was a population-based cohort study of patients with JIA diagnosed following the International League of Associations for Rheumatology (ILAR) classification criteria from 92 United States hospitals. Subjects treated between 2008 and 2023 at 92 United States hospitals were screened. Propensity score matching was used to balance the baseline differences in age of JIA onset, sex, comorbidities, and past medical history between the two groups. The primary predictor variable was any use of TNF-α inhibitor therapy. The primary outcome of interest was the occurrence of new-onset OSA during the follow-up period. A Kaplan-Meier analysis and log-rank tests were utilized to compare the incidence and risk of OSA between the two arms. A Cox proportional hazards model was utilized to estimate the association between the use of TNF-α inhibitors and new-onset OSA.
Results: A total of 608,190 patients with JIA underwent propensity score matching. This resulted in 1,299 included subjects with JIA treated with TNF-α inhibitors, 514 patients developed new-onset OSA after the use of TNF-α inhibitors. In comparison, 594 TNF-α inhibitor non-users developed incident OSA during the follow-up period. Survival analysis suggested a significantly lower incidence of OSA in TNF-α inhibitor users over non-users (log-rank test, p-value < 0.001). Cox proportional hazard regression showed subjects receiving TNF-α inhibitors were associated with a significantly lowered risk of new-onset OSA as compared to non-users (HR=0.87, 95% CI: 0.78, 0.98; RR=0.86, 95% CI: 0.76, 0.96).
Conclusions: Findings in the present study suggested that subjects with JIA treated with TNF-α inhibitors presented with a significantly decreased risk of OSA. This finding was consistent with previous studies reporting that the use TNF-α inhibitors resulted in a significantly lowered risk of OSA and better sleep quality in patients with other inflammatory arthritis such as spondyloarthritis and rheumatoid arthritis [5-7]. Clinical trials are required to validate the findings.
