Background/Purpose:  Systemic Lupus Erythematosus (SLE) patients are known to have sleep disturbances. Quality of sleep may affect quality of life, but this association has not been systematically evaluated. The aim of this study was to examine the distribution and association of quality of sleep and quality of life among patients diagnosed with SLE.

Methods:  SLE outpatients at three rheumatology centers in Western Japan were included in this cross-sectional study. The consented participants completed Japanese versions of the following questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the 12 item Short Form Health Survey (SF-12), and the Lupus Patient-Reported Outcome tool (LupusPRO). Clinical information, including the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), was obtained from medical records. Correlation coefficients (r) were used to measure the associations between the PSQI and the other factors. Stability of quality of sleep was examined by administering the PSQI at baseline (T1) and 2 weeks later (T2).

Results:  The study included 205 SLE patients. The mean age was 47.8±13.6 years (mean SLE duration: 15.0±8.8 years) and >90% were female. The mean SLEDAI score was 3.9±3.7. The majority of the participants (62.9%) had sleep disturbances (PSQI<6.0). Neither the overall PSQI, nor the subcategories were associated with duration of SLE, prednisolone dosage, or SLEDAI. Total PSQI score was weakly associated with all of the SF-12 subcategories (range of r: −0.26–0.39) and showed weak to moderate associations with the LupusPRO subcategories (r: −0.51–0.22), except for “medication”, “procreation”, and “satisfaction with care” (all r<0.20). Analysis of the seven PSQI subcategories revealed that “daytime dysfunction” was weakly to moderately associated with all of the SF-12 subcategories (r: −0.27–0.47) and all of the LupusPRO subcategories (r: −0.59–0.20), except for “procreation” and “satisfaction with care”. However, “sleep duration” was not associated with any of the SF-12 or LupusPRO subcategories. “Sleep efficiency” was weakly associated with “physical health”, “physical function”, and “pain“ in the SF-12 and LupusPRO. “Sleep quality” and “sleep disturbances” were weakly associated with “pain” and the “emotional” and “mental” subcategories in the SF-12 and LupusPRO. The analysis of the stability of sleep quality, revealed a correlation coefficient of 0.79 for the total PSQI scores at T1 and T2. Among the seven PSQI subcategories, the T1 and T2 measurements of “sleep efficiency” and “sleep disturbance” were moderately associated (0.54 and 0.61, respectively), and those for “use of sleep medication” and “sleep latency” were strongly associated (>0.8).

Conclusion:  We found that quality of sleep, especially “sleep efficiency”, was poor for the majority of patients in the sample. Quality of sleep was associated with various aspects of quality of life, especially pain, vitality, and emotional health. Management of pain and emotional health may be important for improving quality of sleep in SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-between-quality-of-sleep-and-quality-of-life-among-japanese-systemic-lupus-erythematosus-outpatients/