Background/Purpose: Sleep disturbance is a common occurrence in musculoskeletal disease including ankylosing spondylitis. The reasons for the sleep disturbance in rheumatic diseases are multifactorial. There are a paucity of studies examining the relationship of sleep disturbance and disease activity in axial SpA patients, with or without TNFi therapy. We set to examine the relationship between sleep quality and disease activity in axial SpA.

Methods: Consecutive patients with axial SpA satisfying the ASAS criteria were asked to fill out a HAQ and BASDAI, prior to seeing a rheumatologist or health care professional. All patients successfully completing both questionnaires at the same visit were included in our study. Demographic information, HLA-B27 status and use of biologic therapy were extracted from the charts. The assessment regarding the quality of sleep was derived from the VAS scale pertaining to a specific question on sleep in the HAQ (question number 4). Quality of sleep then was categorized into three groups based on the VAS score: 0 to 3; 3.1 to 6; and greater than 6.1. The sleep quality was compared to the total BASDAI score and fatigue, as measured by the VAS score from question number 1 from the BASDAI. Spearman’s rank correlation coefficient was done between the categorical sleep score and total BASDAI and fatigue.

Results: 92 patients with axial SpA patients were included which comprised of 65 males, and 52 patients on TNFi. 40 patients had a VAS sleep score between 0-3; 25 between 3.1 to 6 and 27 between 6.1 to 10. Then mean BASDAI score respectively in these three groups were:  2.6 (sd 1.4); 4.5 (sd 1.4) and 6.2 (sd 1.7). So high VAS sleep score (poor sleep) was significantly correlated with higher BASDAI; rho 0.74; p < 0.0001. Patients on TNFi had a significantly lower mean BASDAI score than patients not on a TNFi, however the relationship between quality of sleep and BASDAI was similar between two groups. We observed a higher correlation between sleep pattern and BASDAI in males as compared to females (rho 0.79 vs 0.67 respectively). Sleep score was also significantly correlated with fatigue with mean scores of 2.1 (sd 1.9); 5.7 (sd 1.9) and 6.6 (sd 2.0) respectively in the three groups, rho 0.76; p < 0.0001.

Conclusion: A high VAS sleep score (poor sleep pattern) is associated with higher BASDI score and fatigue, irrespective of treatment with TNFi. Improving sleep hygiene may represent an alternative strategy in lowering disease activity in axial SpA, particularly in male patients.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/poor-quality-of-sleep-is-associated-with-increased-disease-activity-and-fatigue-in-axial-spondyloarthritis/