Worsening of obstructive sleep apnoeas in a patient with rheumatoid arthritis treated with anti-tumor necrosis factor.

We report on a case of an adult patient treated for rheumatoid arthritis with infliximab, a chimerical monoclonal antibody to TNFalpha. Apart from this, the patient also showed clinical signs of obstructive sleep apnea syndrome that was confirmed by polysomnographic study. After infliximab treatment, additional sleep studies revealed an increase in the number of apneic events and SaO2 dips suggesting that TNFalpha plays an important role in the pathophysiology of sleep apnea. Thus, clinical recognition of sleep disordered breathing should be taken into account when rheumatoid arthritis patients are to be treated with infliximab.