Background/Purpose: Sleep disturbance is common in patients with rheumatoid arthritis (RA). Poor sleep can result in increased psychological distress, depression, fatigue, inability to work, socioeconomic burden and consequently significantly decreased health-related quality of life. Achievement and maintenance of tight disease control using disease-modifying anti-rheumatic drugs (DMARDs) including biologic DMARDs (bDMARDs) is associated with significant improvement in the outcome of RA as these strategies have the potential to control synovitis and to slow disease progression. The aim of this study was to assess the relationship between sleep disturbance and disease activity, pain, fatigue, health-related quality of life and treatment.

Methods: A total of 172 participants diagnosed with RA meeting the 2010 ACR/EULAR criteria were enrolled in this study, including 137 females (79.7 %) with a mean age of 44.37 ± 12.90 years. Among all the patients, 110 were treated with conventional DMARDs (cDMARDs), while 62 treated with bDMARDs (47 with tumor necrosis factor inhibitors and 15 with tocilizumab). Participants completed the following questionnaires: Pittsburgh Sleeping Quality Index (PSQI), Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), and Fatigue Severity Scale (FSS). RA disease activity was assessed using the 28 joint disease activity score (DAS28), erythrocyte sedimentation rate, serum C-reactive protein and pain visual analog scale (VAS). Data were analyzed using SPSS v.17.0 software by descriptive statistics such as frequency, mean (SD) and inferential statistics including Wilcoxon rank sum test, Chi-square, and logistic regression.

Results were considered statistically significant when p value was less than 0.05. Results: PSQI was used to assess the quality of sleep in RA patients. Sleep disturbance was considered if PSQI score was greater than 6. Sleep disturbance was present in 46.5% (80/172) of RA patients and was associated with disease activity. Compared with RA patients without sleep disturbance, RA patients with sleep disturbance had increased pain levels, poor health-related quality of life, depression and fatigue as assessed by VAS (p<0.01), HAQ (p<0.05), HADS (p<0.05) and FSS (p<0.01) respectively. Better disease control could improve the quality of sleep in RA patients. In addition, patients treated with bDMARDs had significantly lower scores of DAS28 (p<0.01), PSQI (p<0.01) and VAS (p<0.05) compared to those treated with cDMARDs (Table 1).

Conclusion: High prevalence of sleep disturbance in patients with RA was observed. Sleep disturbance was associated with several measurements of health-related quality of life. Control of disease activity improved sleep disturbance. Treatment with bMARDs not only had better disease control, but also improved functional status by improving quality of sleep and pain.

Table1.Association of sleep disturbance with disease activity and other measurements of health-related quality of life in RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sleep-disturbance-in-patients-with-rheumatoid-arthritis-a-cross-section-study/