Anti-Citrullinated Cyclic Peptide Antibody and Functional Disability Are Associated With Poor Sleep Quality in Rheumatoid Arthritis

Objective.To evaluate a multidimensional model testing disease activity, mood disturbance, and poor sleep quality as determinants of fatigue in patients with rheumatoid arthritis (RA).Method.The data of 106 participants were drawn from baseline of a randomized comparative efficacy trial of psychosocial interventions for RA. Sets of reliable and valid measures were used to represent model constructs. Structural equation modeling was used to test the direct effects of disease activity, mood disturbance, and poor sleep quality on fatigue, as well as the indirect effects of disease activity as mediated by mood disturbance and poor sleep quality.Results.The final model fit the data well, and the specified predictors explained 62% of the variance in fatigue. Higher levels of disease activity, mood disturbance, and poor sleep quality had direct effects on fatigue. Disease activity was indirectly related to fatigue through its effects on mood disturbance, which in turn was related to poor sleep quality. Mood disturbance also indirectly influenced fatigue through poor sleep quality.Conclusion.Our findings confirmed the importance of a multidimensional framework in evaluating the contribution of disease activity, mood disturbance, and sleep quality to fatigue in RA using a structural equation approach. Mood disturbance and poor sleep quality played major roles in explaining fatigue along with patient-reported disease activity.

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A cross-sectional study of sleep and depression in a rheumatoid arthritis population

Clinical Rheumatology ◽

10.1007/s10067-020-05414-8 ◽

2020 ◽

Author(s):

Mark Hughes ◽

Alan Chalk ◽

Poonam Sharma ◽

Sandeep Dahiya ◽

James Galloway

Keyword(s):

Rheumatoid Arthritis ◽

Sleep Quality ◽

Cross Sectional Study ◽

Poor Sleep ◽

Comorbid Depression ◽

Poor Sleep Quality ◽

Cross Sectional ◽

Rheumatoid Arthritis Population ◽

Impaired Sleep

Abstract Objectives To assess the prevalence of impaired sleep quality and depression in a rheumatoid arthritis population and determine their correlation with Disease Activity Score (DAS) and its components. Methods In this single-centre observational cross-sectional study, data was collected by the assessing clinician for DAS28, age and gender in various treatment groups according to use of csDMARDs, biologics and long-term steroids. Presence of impaired sleep quality and depression was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Public Health Questionnaire 9 (PHQ 9). Correlation for DAS and its components with the outcomes was determined by Pearson’s correlation coefficient. Multivariate analysis was performed by logistic regression. Results Two hundred patients were included. The prevalence across all subgroups of poor sleep quality and depression were 86.5% and 30%, respectively, with a correlation coefficient of 0.69 between the two and poor sleep quality amongst all RA patients with comorbid depression. Multivariate analysis found only subjective DAS components, tender joint count (TJC) and patient global health visual analogue score (VAS) to significantly correlate with both outcomes. Age inversely correlated with depression. Long-term steroid use was associated with poorer sleep quality, but there was no significant effect of csDMARDs or biologics. There was no significant difference in prevalence of depression amongst treatment subgroups. Conclusion Poor sleep quality and to a lesser extent depression are prevalent in the general rheumatoid arthritis population. Patients would benefit from clinicians measuring these outcomes routinely as they constitute a significant non-inflammatory burden of living with rheumatoid disease. Key Points• Subjective components of DAS independently correlate with sleep quality and depression, while objective components do not.• Poor sleep quality is highly prevalent in RA and present in all those with comorbid depression.• Poor sleep quality and depression incidence in RA are much lower when DAS is low or remission.

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POS0159-HPR IMPACT OF SLEEP DISTURBANCES ON ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.408 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 292.1-292

Author(s):

M. Sellami ◽

O. Hamdi ◽

S. Miladi ◽

A. Fazaa ◽

L. Souabni ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Elderly Patients ◽

Sleep Quality ◽

Disease Activity ◽

Functional Status ◽

Sleep Disturbances ◽

Tender Joint Count ◽

Poor Sleep ◽

Poor Sleep Quality ◽

The Mean

Background:Sleep disturbances have been reported in various rheumatic diseases especially in the elderly. It may be caused by pain and depressive mood. However, reports on the impact of sleep problems in rheumatoid arthritis (RA) activity and functional status were limited.Objectives:To assess sleep quality in elderly patients with RA and its impact on disease activity and functional status.Methods:This cross-sectional study included 70 RA patients aged ≥ 65 years fulfilling the ACR/EULAR criteria. Sociodemographic data were collected. RA activity was assessed with the Disease Activity Score (DAS28) and functional status with the Health Assessment Questionnaire (HAQ). Sleep quality was assessed using Arabic translated versions of two indexes: the Insomnia Severity Index (ISI) and the Pittsburg Sleep Quality Index (PSQI). An ISI score of [8-14], [15-21], and [22-28] determined respectively mild, moderate, and severe insomnia. A PSQI score > 5 determined poor sleep quality. ANOVA test was used to assess the relationship between DAS28 erythrocyte sedimentation rate (ESR), HAQ, and sleep quality indexes.Results:This study included 52 females and 18 males with a mean age of 68.3 ± 25 years [65-81]. Seventy percent of patients were married, 27% were widowed and 2% were divorced. Seventy-one percent of patients were illiterate, 18% had primary education and 11% had secondary education. Eighteen percent of patients were employed whereas 34.7% were retired. A history of depression was noted in 16.5% of patients. The mean duration of RA was 17.4 ± 5.2 years. Eighty-five percent of patients were on conventional synthetic DMARD whereas 15% were treated with biologic treatment. The mean patient’s global assessment of disease activity was 5.2 ± 1.3. The mean tender joint count and mean swollen joint count were 8 ±1.5 and 5 ±1 respectively. The mean DAS28 ESR was 4.7 ±0.9. The mean HAQ was 2.4 ± 0.45. Poor sleep quality was detected in 84% of cases according to the PSQI score. Mild insomnia was detected in 46% of cases, moderate insomnia in 34% of cases, and severe insomnia in 12% of cases. RA activity was higher in patients with poor sleep quality: the mean DAS28 ESR was 5.2 in patients with severe insomnia, 4.82 in moderate insomnia, and 4.13 in mild insomnia; p= 0.00 respectively. The mean ESR was 31.5 mm in patients with severe insomnia, 22.1 mm in moderate insomnia, and 10.6 mm in mild insomnia; p= 0.01 respectively. Furthermore, the higher the PSQI was, the higher DAS28 ESR is (p =0.01). However, no association was found between poor sleep quality and joint count, swollen joint count, CRP, and HAQ.Conclusion:Disease activity was a major contributor to poor sleep quality in elderly patients with RA. Functional status however wasn’t associated with insomnia. Physicians should include sleep in the clinical assessment of RA patients to improve their quality of life.Disclosure of Interests:None declared

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FRI0178 PREDICTIVE FACTORS FOR POOR SLEEP QUALITY IN SYSTEMIC LUPUS ERYTHEMATOSUS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.931 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 673.2-673

Author(s):

R. Magro ◽

L. Camilleri ◽

A. Borg

Keyword(s):

Systemic Lupus Erythematosus ◽

Sleep Quality ◽

Predictive Factors ◽

Lupus Erythematosus ◽

Quality Index ◽

Functional Disability ◽

Pittsburgh Sleep Quality Index ◽

Poor Sleep ◽

Systemic Lupus ◽

Poor Sleep Quality

Background:Poor sleep quality is common in systemic lupus erythematosus (SLE) and could contribute to fatigue, which is regarded as one of the most disabling symptoms in SLE. The Pittsburgh sleep quality index (PSQI) is a validated self-administered questionnaire that measures sleep quality over the previous month.1Objectives:The aim of this study was to analyse the relationship of sleep quality with several variables including depression, anxiety, pain, disease activity, fatigue and functional disability in patients with SLE. A further aim was to establish the prevalence of poor sleep quality in SLE.Methods:A cohort cross-sectional study was carried out including 92 SLE patients who fulfilled the SLICC classification criteria for SLE and who provided informed consent for participation. The patients were interviewed and they were asked to fill in questionnaires including PSQI, Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS) for pain and modified Health Assessment Questionnaire (mHAQ). Blood and urine tests enabled the calculation of SLE disease activity index-2K (SLEDAI-2K). The study was approved by the University Research Ethics Committee.Results:92.4% of the cohort studied were females, and the mean age was 46.9 years (range 19-79 years). 55.4% were noted to have poor quality sleep (PSQI >5), and the median PSQI was 6 (range 0-18). Sleep quality measured by PSQI, had a significant correlation with SLEDAI-2K (R=0.254, p=0.014), VAS pain (R=0.515, p<0.001), HADS-D (R=0.605, p<0.001), HADS-A (R=0.375, p<0.001), estimated glomerular filtration rate (eGFR) (R=-0.211, p=0.044), FSS (R=0.551, p<0.001) and mHAQ (R=0.559, p<0.001). ANCOVA analysis showed that PSQI was significantly dependant on VAS pain (p<0.001), HADS-D (p<0.001) and eGFR (p=0.003).Conclusion:Poor sleep quality is highly prevalent in SLE patients. This study has shown that the strongest predictive factors for poor sleep quality are pain, depression and impaired renal function. Since poor sleep quality is significantly related to fatigue and functional disability, its identification and management is important for patients’ wellbeing.References:[1]Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28: 193 – 213.Disclosure of Interests:None declared

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P171 Factors determining sleep quality in SLE

Rheumatology ◽

10.1093/rheumatology/keaa111.166 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Rosalie Magro ◽

Liberato Camilleri ◽

Andrew A Borg

Keyword(s):

Sleep Quality ◽

Disease Activity ◽

Lupus Erythematosus ◽

Functional Disability ◽

Activity Index ◽

Depression Scale ◽

Disease Activity Index ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional

Abstract Background Poor sleep quality is common in systemic lupus erythematosus (SLE) and could contribute to fatigue, which is regarded as one of the most disabling symptoms in SLE. The Pittsburgh sleep quality index (PSQI) is a validated self-administered questionnaire that measures sleep quality over the previous month. The aim of this study was to analyse the relationship of sleep quality, measured by PSQI, with several variables including depression, anxiety, pain, disease activity, fatigue and functional disability in patients with SLE. A further aim was to establish the prevalence of poor sleep quality in SLE. Methods A cohort cross-sectional study was carried out including 92 SLE patients who fulfilled the SLICC classification criteria for SLE and who provided informed consent for participation. The patients were interviewed, and they were asked to fill in questionnaires including PSQI, Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS) for pain and modified Health Assessment Questionnaire (mHAQ). Blood and urine tests enabled the calculation of SLE disease activity index-2K (SLEDAI-2K). The study was approved by the University Research Ethics Committee. Results 92.4% of the cohort studied were females, and the mean age was 46.9 years (range 19-79 years). 55.4% were noted to have poor quality sleep (PSQI >5), and the median PSQI was 6 (range 0-18). Sleep quality measured by PSQI, had a significant correlation with SLEDAI-2K (R = 0.254, p = 0.014), VAS pain (R = 0.515, p < 0.001), HADS-D (R = 0.605, p < 0.001), HADS-A (R = 0.375, p < 0.001), estimated glomerular filtration rate (eGFR) (R=-0.211, p = 0.044), FSS (R = 0.551, p < 0.001) and mHAQ (R = 0.559, p < 0.001). ANCOVA analysis showed that PSQI was significantly dependant on VAS pain (p < 0.001), HADS-D (p < 0.001) and eGFR (p = 0.003). Conclusion Poor sleep quality is highly prevalent in SLE patients. This study has shown that the strongest predictive factors for poor sleep quality are pain, depression and impaired renal function. Since poor sleep quality is significantly related to fatigue and functional disability, its identification and management is important for patients’ wellbeing. Disclosures R. Magro None. L. Camilleri None. A.A. Borg None.

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Dose-response Relationship between Sleep and Rheumatoid Arthritis

American Journal of Health Behavior ◽

10.5993/ajhb.44.1.5 ◽

2020 ◽

Vol 44 (1) ◽

pp. 40-53

Author(s):

Wenwen Wu ◽

Jinru Yang ◽

Yaohua Gu ◽

Xuyu Chen ◽

Xiaodong Tan

Keyword(s):

Rheumatoid Arthritis ◽

Sleep Quality ◽

Sleep Duration ◽

Low Income ◽

Rural Areas ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Short Sleep ◽

Increased Risk

Objectives: In this study, we explored the association between sleep quality, duration and prevalence of rheumatoid arthritis (RA) among low-income adults in rural areas of China. Methods: Face-to-face investigation were conducted in 2017, and completed questionnaires were obtained from 16,648 individuals. Sleep quality and duration were evaluated using the standard Pittsburgh Sleep Quality Index. RA was based on self-reported physician diagnosis. Logistic regression analysis and restricted cubic spline models were performed. Results: Sleep duration shorter than 7 hours was associated with increased odds of RA, with an odds ratio (OR) of 1.49 for 6–<7 hours and 1.70 for <6 hours. Poor sleep quality was associated with RA, with an OR of 1.68. The combination category of poor sleep quality and any group of sleep duration was associated with a significantly increased risk of developing RA. Combined groups of good sleep quality with short sleep duration (<7 hours) were also found to be related to prevalence of RA. There was a non-linear relationship between sleep quality, duration and the odds of RA. Conclusions: Poor sleep quality and short sleep duration may be trigger or risk factors for RA.

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