Background/Purpose: Sleep is an essential health aspect that is often impacted in patients with axial spondyloarthritis (axSpA). This analysis aims to assess the prevalence and associated factors of sleep disorders in a large sample of European axSpA patients.

Methods: Data were analyzed from 2,846 unselected patients with self-reported clinician-given diagnosis of axSpA of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries. Socio-demographic data; BASDAI [0-10] scores; engagement in physical activity; axSpA influence on work choice (assessed with yes/no question “Was your current or past work choice in any way determined by axSpA?”),; risk of psychological distress (12-item General Health Questionnaire [GHQ-12; 0-12]); functional limitation [0-54] and self-reported anxiety and depression were evaluated. Presence of sleep disorders was assessed by the question: “Please indicate whether you have been diagnosed with any of the following: sleep disorders”. A Mann-Whitney test was used to compare the means of numerical variables between dichotomous variables, the Chi-Square test was used to compare the distribution between the categorical variables. Simple and multivariable logistic regression models were used to identify associations between sleep disorders and disease characteristics, mental health and work-related variables.

Results: Age of respondents was 43.9 years; 61.3% were female; 48.1% had a university degree; 67.9% were married and 71.3% were HLA-B27 positive. The prevalence of sleep disorders was 39.0%. In the bivariate analysis, presence of sleep disorders was associated with female gender (68.3% vs. 31.7%; p< 0.001); overweight/obese (56.5% vs. 49.8%; p< 0.001); increased BASDAI scores (6.1±1.8 vs. 5.0±2.1; p< 0.001); fatigue (7.0±2.0 vs. 5.8±2.4; p< 0.001); morning stiffness (5.8±2.4 vs. 4.8±2.4; p< 0.001), work impact (56.5% vs. 38.2%; p< 0.001); anxiety (56.8% vs. 12.5%; p< 0.001); depression (51.8% vs. 10.1%; p< 0.001) and higher GHQ-12 scores (6.4±4.0 vs. 3.9±3.9; p< 0.001) [Table 1]. However, factors that remained independently associated with sleep disorders in the multivariable analysis were anxiety (OR=3.8 p< 0.001) and depression (OR=3.1 p< 0.001) and female gender (OR=1.4; p=0.002) [Table 2]. According to employment status, the greatest prevalence of sleep disorders was concentrated in those on permanent sick leave (52.3%) and temporary sick leave (50.2%). [Table 3].

Conclusion: Sleep disorders were highly prevalent among axSpA European patients and strongly associated with female gender and reporting worse mental health, and spinal stiffness. Patients on permanent and temporary sick leave were more likely to report sleep disorders. The strong association between sleep disorders with both anxiety and depression should encourage rheumatologists to screen their patients with sleep disturbance in case they require additional specialist support.

Table 1. Sociodemographic characteristics and patient-reported outcomes by presence of sleep disorders (N = 2713, unless otherwise specified)

Table 2. Regression analysis to predict presence of sleep disorders (N = 2191)

Table 3. Presence of sleep disorders according to employment status categories (N = 2,580)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-associated-factors-of-sleep-disorders-in-patients-with-axial-spondyloarthritis-results-from-the-european-map-of-axial-spondyloarthritis-emas/