Background/Purpose: Lupus patients commonly report sleep dysfunction, which is associated with upregulation of inflammatory cytokines in healthy people. Studies exploring relationships between self-reported sleep dysfunction and SLE have yielded conflicting results. The objective of our study was to evaluate the relationship between sleep and SLE disease activity in a large, ethnically diverse cohort of adult lupus patients.

Methods: 141 patients meeting ACR classification criteria for SLE completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Short Form 8b and Sleep Related Impairment Short Form 8a. Correlations between sleep scores and the SLE Disease Activity Instrument (SLEDAI) were tested by Spearman correlation. Upper and lower quartile proportions and associations were compared by Chi-square. Patients completing sleep assessments at ≥2 visits (n=69) were examined for intra-patient variability with mixed linear regression to model relationships between SLEDAI and sleep disturbance or impairment.

Results:

Participants were mostly Caucasian (50.4%) or African American (29.1%) and female (90.1%), with median age of 42. Sleep disturbance and impairment was increased compared to the national average (median T-scores of 56.3 and 55.6, respectively, vs. average of 50). Patients in the upper quartile of SIS and SDS did not differ in SLEDAI score compared to patients in the lowest quartile of SIS and SDS. However, SLE patients with the poorest sleep were more likely to have anti-dsDNA (OR 3.33, 95% CI 1.43, 10.0; p<0.01) and less likely to be scored for arthritis than those with the least sleep impairment (OR 0.185, 0.050, 0.690; p<0.05). Within individuals, sleep disturbance and sleep impairment did not correlate with total SLEDAI scores (r2 = -0.0859 and r = -0.125, respectively; p>0.05). Adding medication usage covariates showed that sleep inducing agents (coefficient = -2.02; p<0.05) were associated with a decreased SLEDAI score, and steroid use (0.707; p<0.05) was associated with an increased SLEDAI score.

Conclusion: We found higher rates of sleep dysfunction in SLE than the national average which was not accounted for by SLEDAI scores. The possibility of immune phenotypes (anti-dsDNA) or medications contributing to sleep dysfunction should be further studied as improved sleep may be associated with health benefits such as decreased pain, less depression or minimization of co-morbid fibromyalgia.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-activity-by-the-sledai-in-lupus-patients-who-self-report-sleep-disturbance-and-sleep-impairment-using-the-patient-reported-outcomes-measurement-information-system-instruments/