Clinical and Psychological Correlates of Sleep Difficulties in Patients with Spondyloarthropathies Compared to Patients with Rheumatoid Arthritis

Konstantinos Kotsis¹, Thomas Hyphantis², Paraskevi V. Voulgari³, Andre F. Carvalho⁴ and Alexandros A. Drosos⁵, ¹Department of Psychiatry, Medical School, University of Ioannina, 45110, Ioannina, Greece., Department of Psychiatry, Medical School, University of Ioannina, 45110, Ioannina, Greece., Ioannina, Greece, ²Department of Psychiatry, Medical School, University of Ioannina, Ioannina 45110, Greece., Department of Psychiatry, Medical School, University of Ioannina, Ioannina 45110, Greece., Ioannina, Greece, ³Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Associate Professor of Rheumatology, Ioannina, Greece, ⁴Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil., Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil., Fortaleza, Brazil, ⁵Rheumatology Clinic, Department of Internal Medicine, University of Ioannina, Ioannina, Greece

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Rheumatoid arthritis (RA), sleep disorders and spondylarthropathy

Session Information

Title: Spondyloarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment I

Session Type: Abstract Submissions (ACR)

Background/Purpose Sleep difficulties are common in patients with rheumatological disorders. Patients with Rheumatoid Arthritis (RA) report frequently poor quality sleep, numerous night awakening and difficulty falling asleep; complaints of patients with Spondyloarthropathies (SpA) often include poor sleep quality, sleep-onset insomnia and difficulty awakening. The aim of the present study was to test whether the clinical and psychological factors associated with sleep difficulties are different in patients with SpAs compared to RA patients.

Methods In 138 consecutive SpA patients (55 with Ankylosing Spondylitis (AS) and 83 with Psoriatic Arthritis) we assessed disease’s parameters, pain, depressive symptom severity (PHQ-9), Illness Perceptions (B-IPQ) and sleep difficulties (SCL-90-R). One hundred and ninety-nine consecutive RA patients served as disease control group. Multiple regression models determined the associations of clinical and psychological variables with sleep difficulties separately for each disease-group.

Results SpA patients reported more waking up early in the morning (p=0.012) and less difficulties in falling asleep (p<0.001) and restless sleep (p=0.002) compared to RA patients. Depressive symptoms were associated with sleep difficulties in both disease-groups. In RA, older age (p=0.038) and female gender (p=0.016) were associated with more difficulties in falling asleep; female gender was correlated with waking up early in the morning (p=0.028), and disease activity, as measured by the DAS-28, was associated with restless sleep (p=0.004). However, pain was associated with troubles falling asleep (p=0.009) and sleep restlessness (p<0.001) only in patients with SpA. In addition, in patients with SpA, the higher the number of bodily symptoms attributed to the illness (illness identity), the greater the waking up early in the morning (p=0.05).

Conclusion Apart from early recognition and treatment of depressive symptoms in both SpA and RA, addressing pain issues should be considered a priority in patients with SpA, as axial pain and stiffness in the latter half of the night are an important characteristic of the inflammatory back pain in those patients with AS, resulting in sleep disturbances, as the present findings showed. Attention to patients’ illness perceptions and their concerns about numerous bodily symptoms attributed to the illness may also enable rheumatologists to identify and manage treatable aspects of sleep difficulties in patients with SpA.

Disclosure:

K. Kotsis,
None;

T. Hyphantis,
None;

P. V. Voulgari,
None;

A. F. Carvalho,
None;

A. A. Drosos,
None.

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