Background/Purpose: Rheumatoid arthritis (RA) patients commonly complain of sleep problems.  Difficulties with sleep may be associated with increased fatigue, greater pain and worse quality of life.  We aimed to establish the prevalence of sleep problems among RA patients and to characterize these sleep problems based on survey and polysomnographic measurements.

Methods: We conducted a systematic literature review to identify studies reporting the prevalence and characteristics of sleep problems in RA.  Pubmed searches were conducted using MESH keywords for “Arthritis, Rheumatoid,” “Sleep,” Sleep Disorders”, and “Fatigue”, for studies published worldwide in English between August 1989 and April 2012. Further articles were obtained from the reference lists of these articles.  Articles were selected based on title, abstract and manuscript review.  Inclusion criteria included studies focusing on sleep problems in adult-onset RA patients.  Review articles, case reports, and qualitative studies were excluded. One author (CC) screened titles and abstracts. Both authors independently extracted data from the articles. Data regarding the prevalence of sleep problems and specific types of sleep problems were extracted, and ranges of values and median of means are reported.

Results: The literature search identified 1410 articles of which 23 were included in the review.  Of these articles, 8 had specific measures of the prevalence of sleep problems, and 18 used survey and/or polysomnograph methods to characterize these problems based on sleep duration, sleep efficiency and sleep disturbance.  Only 5 articles had data comparing RA patients to controls (Table). Methods and scales for evaluating prevalence and characteristics of sleep disturbances varied greatly among these articles. The prevalence of sleep problems ranged from 60-97% by self-report questionnaires.  The Pittsburgh Sleep Quality Index score, reflecting sleep quality, sleep latency, sleep efficiency, sleep disturbance, and sleep duration, was markedly higher, signifying poorer sleep, in RA patients compared to control patients. Polysomnograph studies also indicated lower sleep efficiency, increased number of awakenings, and longer sleep latency among RA patients compared to control subjects.  However, mean hours of sleep, measured by polysomnograph, were similar among RA patients compared to controls.

Conclusion: Sleep disturbances, notably increased awakenings, were reported by the majority of RA patients, while sleep duration was similar among RA patients compared to controls.  These results suggest that widespread sleep problems among RA patients may be a result of disturbed sleep rather than an overall lack of sleep. Future studies are needed using uniform sleep measures in large cohorts of well-characterized RA patients with appropriately selected controls.