Background/Purpose: Autoimmune Rheumatic Diseases (ARDs) commonly present with psychiatric symptoms such as chronic fatigue, depression, and anxiety, and often linked to poor sleep quality. Prolonged inflammation, elevated cytokines, chronic pain, and medication side effects may contribute to these disturbances. Sleep quality can be assessed by the Pittsburgh Sleep Quality Index (PSQI), a validated tool evaluating overall sleep and its 7 components.
We aim to describe sleep quality in ARDs patients and its relationship with anxiety, depression, and fatigue.

Methods: A cross-sectional, observational study was conducted at a university hospital’s Rheumatology Clinic (June 2024–April 2025). Adults (≥18 years) with a previous ARDs diagnosis were included. Fatigue was measured using the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F, cut-off < 30) Scale, anxiety and depression with the Hospital Anxiety and Depression Scale (HADS; 8–10 mild, ≥11 severe), and sleep quality via PSQI (total scores >5 indicate poor sleep).

Results: Of the 176 ARDs patients, 170 (96.5%) were women, with a median age of 46.25 ±15.95 years. Rheumatoid Arthritis (RA) (n=71, 40.3%) and Systemic Lupus Erythematosus (SLE) (n=55, 31.25%) were the most common ARDs. Poor sleep quality was found in 102 patients (58%) vs. 74 (42%) good sleepers; PSQI medians were 9.5 (7–13) vs. 4 (3–4.25) (p< 0.001). Among RA and SLE patients, 93 (52.8%) had remission/low activity, while 40 (22.7%) had moderate/severe activity. A tendency was found between disease activity and poor sleep (p=0.058), with 28.4% of poor sleepers showing severe activity. Glucocorticoid use was more prevalent in poor sleepers (43.1% vs. 29.7%). Comorbidities affected 123 patients (69.88%), slightly more common among poor sleepers (74.5% vs. 63.5%, p=0.135).Poor sleepers had significantly more severe anxiety (27.5%, p< 0.001) and depression (9.8%, p=0.024), with higher median HADS scores for anxiety [7 (4–10) vs. 3 (1–5)] and depression [5 (2–9) vs. 2 (1–4)]. Fatigue was also more common in poor sleepers (49% vs. 17.6%), with lower FACIT-F scores [31 (23–40) vs. 43 (37.7–48), p< 0.001]. Poor sleepers and patients with anxiety showed significantly worse scores across all seven sleep quality components (p < .001). Among those with depression, most components were significantly affected, except sleep latency and duration. Also, fatigue was strongly associated with all components except for sleep latency.

Conclusion: Over half of ARDs patients (58%) experienced poor sleep quality. Poor sleep quality demonstrated a strong association with elevated anxiety and fatigue levels, while the prevalence of depression among poor sleepers was more than double compared to good sleepers. These results emphasize the link between sleep and mental health in ARDs, highlighting the need for comprehensive care strategies targeting both physical and psychological well-being.

Table 1. Sociodemographic and clinical variables in ARDs patients

Table 2: Sleep Quality Associated With Fatigue, Anxiety, and Depression; Scores and Prevalence

Table 3. Pittsburgh Sleep Quality Index (PSQI) Scores in Bad Sleepers, Anxiety, Depression and Fatigue

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relationship-between-sleep-quality-and-psychiatric-symptoms-in-autoimmune-rheumatic-diseases/