Session Information
Title: Health Services Research, Quality Measures and Quality of Care - Innovations in Health Care Delivery
Session Type: Abstract Submissions (ACR)
Patient’s Response To A Sleep Question And Disease Activity Levels In Multiple Rheumatic Conditions
Background/Purpose:
Sleep disturbances can have an impact on the quality of life of any individual. Research studies have shown a significant association between sleep disturbances and a number of chronic inflammatory conditions, including Asthma and Crohn’s disease. This study aims to determine the significance of sleep disturbances in patients diagnosed with various rheumatic conditions, and its association with disease activity levels.
Methods:
All patients with any rheumatologic diagnosis attending a single rheumatology practice were asked to complete a MDHAQ. The MDHAQ includes sections regarding function, pain, patient global estimate, a patient self-reported joint count, fatigue, exercise, AM stiffness and a brief psychological profile. The MDHAQ includes 3 psychological profile queries, including “Over the past week, were you able to get a good night’s sleep?” The responses are 0-3 which stand for, 0=without difficulty, 1= with some difficulty, 2= with much difficulty, 3=unable to do. RAPID3 is an index of the 3 patient-reported outcome measures: physical function, pain and patient global estimate. RAPID3 can be calculated from a MDHAQ in less than 10 seconds. Patients are then characterized into disease activity categories (“remission”, “low disease activity”, “moderate disease activity”, “high disease activity”), according to established criteria. Using a random visit for each patient, linear regression models were determined using the composite score value as the dependent variable, and “sleep” as the independent variable, to determine possible interactions between “sleep”score and disease activity scores. All statistical analyses were performed using Stata v12.
Results:
We analyzed data on total of 786 patients diagnosed with a non-overlapping rheumatic disease and who had completed the MDHAQ survey. The number of patients diagnosed with a particular rheumatic disease is shown in the table below. The rheumatic conditions studied are Rheumatoid Arthritis (RA), Osteoarthritis (OA), Fibromyalgia, SLE, Psoriatic Arthritis (PsA), Spondyloarthropathies, and Gout. A “linear” worsening of RAPID3 was seen with each increment of sleep variable.
(Table)
Conclusion:
Interestingly, patients affected by a myriad of chronic inflammatory rheumatic diseases perceive significant sleep disturbances, at any given point of time during the course of their disease process. Patients with worse sleep scores are less likely to be in low disease activity as measured by RAPID3. Interventions in chronic rheumatic diseases are often targeted to impact symptoms of joint pain / function. Further interventions may be needed to improve strategies designed for the improvement of psychological profile, especially sleep disorders.
|
Rheumatic conditions
|
Observation
|
Sleepinc=0 (p-value)
|
Sleepinc=1 (p-value)
|
Sleepinc=2 (p-value)
|
Sleepinc=3 (p-value)
|
R-squared
|
|
Rheumatoid Arthritis (RA) |
195 |
5.38 (<0.01) |
10.69 (<0.01) |
15.45 (<0.01) |
17.40 (<0.01) |
0.33 |
|
Osteoarthritis (OA) |
232 |
9.31 (<0.01) |
11.38 (<0.01) |
15.73 (<0.01) |
17.98 (<0.01) |
0.17 |
|
Fibromyalgia |
52 |
9.96 (<0.01) |
13.51 (<0.01) |
18.39 (<0.01) |
19.79 (<0.01) |
0.25 |
|
SLE |
53 |
4.54 (0.003) |
8.4 (<0.01) |
13.91 (<0.01) |
12.16 (0.008) |
0.23 |
|
Psoriatic Arthritis (PsA)
|
60 |
5.34 (<0.01) |
10.35 (<0.01) |
16.24 (<0.01) |
19.77 (<0.01) |
0.42 |
|
Spondyloarthropathies |
113 |
4.82 (<0.01) |
10.04 (<0.01) |
16.96 (<0.01) |
20.16 (<0.01) |
0.52 |
|
Gout |
81 |
5.20 (<0.01) |
9.82 (<0.01) |
17.10 (<0.01) |
21.05 (<0.01) |
0.37 |
Disclosure:
S. Sangani,
None;
M. J. Bergman,
None.
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