ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1644

Less Than Seven Hours of Sleep per Night Is Associated with Transitioning to Systemic Lupus Erythematosus

Kendra A. Young1, Melissa E. Munroe2, Joel M. Guthridge3, Diane L. Kamen4, Gary S. Gilkeson5, Michael Weisman6, David Karp7, John B. Harley8, Daniel J. Wallace6, Judith A. James9 and Jill M. Norris10, 1Epidemiology, University of Colorado Denver, Aurora, CO, 2Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 3Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, OKC, OK, 4Medicine/Rheumatology & Immunology, Medical University of South Carolina, Charleston, SC, 5Department of Medicine, Medical University of South Carolina, Charleston, SC, 6Cedars-Sinai Medical Center Division of Rheumatology, Los Angeles, CA, 7Rheumatology, UT Southwestern Med Ctr, Dallas, TX, 8Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 9Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 10Department of Epidemiology, Colorado School of Public Health, Aurora, CO

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords:

Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with a relatively unknown etiology. The quality and quantity of sleep has been shown to have significant impacts on health. However, the role of sleep in the etiology of human SLE has not been studied. We examined whether reported sleep duration at baseline was prospectively associated with transitioning to SLE at follow-up in individuals at risk for SLE, independent of early clinical manifestations associated with SLE such as depression, fatigue, anxiety, or medication use.

Methods: 436 individuals who reported having a relative with SLE but who did not have SLE themselves at baseline were evaluated again an average of 6.3 years later. Fifty-six individuals transitioned to SLE by follow-up (> 4 cumulative ACR criteria verified by medical record review). Sleep duration, medication use, and clinical manifestations such as depression, fatigue, anxiety, or prednisone use, were assessed by questionnaire; ACR criteria were confirmed by medical record. We dichotomized sleep duration as <7 hours of sleep a night or ≥ 7 hours of sleep a night, based on the Institute of Medicine recommendations. Generalized estimating equations, accounting for correlation within families, were used to assess associations between baseline sleep and the outcome of transitioning to SLE. In addition, to determine if the association between sleep duration and SLE was independent of early SLE symptoms, we additionally adjusted for other sleep associated variables at baseline, including depression, prednisone use, chronic fatigue, anxiety and number of ACR criteria. All multivariable models were adjusted for age, sex, and race.

Results: Sleeping less than the recommended 7 hours of sleep per night was greater in those who transitioned compared to those who did not transition to SLE (61% versus 34%, p=0.0002; OR: 2.8, 95% 1.6-4.9). A higher proportion of those who transitioned reported sleep medication and prednisone use, depression, fatigue, and anxiety at baseline. Those who transitioned to SLE were more likely to sleep less than 7 hours a night at baseline than those who did not transition to SLE adjusting for age, sex and race (OR: 2.9, 95% CI 1.6-5.1) (Model 1 in Table 1). This association remained after adjustment for baseline conditions and early pre-clinical manifestations that could affect sleep, including prednisone use, depression , chronic fatigue , anxiety , and number of ACR criteria.

Conclusion: Lack of sleep may be associated with transitioning to SLE, independent of early clinical manifestations of SLE that may influence sleep duration. Sleep loss may deregulate immune responses, leading to increased inflammatory cytokines and increased white blood cell and natural killer cell counts. Further prospective evaluation of sleeping patterns and biomarkers in at-risk individuals is warranted.

Table 1. Less Than Seven Hours of Sleep a Night is Associated with Transitioning to SLE.

Transitioned to SLE (Odds Ratio (95% CI))

Baseline Characteristics

Model 1

Model 2

Model 3

Model 4

Model 5

Model 6

Sleep <7 hours

2.9 (1.6-5.1)

2.1 (1.1-4.2)

2.5 (1.4-4.6)

2.1 (1.1-3.9)

2.5 (1.4-4.5)

2.3 (1.2-4.5)

Prednisone Use

–

15.5 (7.7-31.4)

–

–

Self-reported depression

–

–

3.6 (1.9-6.7)

–

–

Self-reported chronic fatigue

–

–

–

18.3 (7.7-43.1)

–

–

Self-reported anxiety

–

–

–

–

2.8 (1.6-5.0)

–

ACR criteria:

0-1

2

3

–

–

–

_

1.0 (ref)

13.4 (5.3-34.3)

180.8 (27.8-1174.4)

All models adjusted for age, sex and race (nonEA).

Disclosure: K. A. Young, None; M. E. Munroe, None; J. M. Guthridge, None; D. L. Kamen, None; G. S. Gilkeson, None; M. Weisman, None; D. Karp, None; J. B. Harley, None; D. J. Wallace, None; J. A. James, None; J. M. Norris, None.

To cite this abstract in AMA style:

Young KA, Munroe ME, Guthridge JM, Kamen DL, Gilkeson GS, Weisman M, Karp D, Harley JB, Wallace DJ, James JA, Norris JM. Less Than Seven Hours of Sleep per Night Is Associated with Transitioning to Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/less-than-seven-hours-of-sleep-per-night-is-associated-with-transitioning-to-systemic-lupus-erythematosus/. Accessed .

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