Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Although studies to date have suggested sleep disturbance among individuals with SLE, prior studies have been small and have examined a limited number of outcomes. We examined the relationship between sleep disturbance and a range of patient-reported outcomes (PROs), both concurrently and longitudinally, in a large cohort of individuals with SLE.
Methods: Data from the Lupus Outcomes Study (2010-2012; n = 711), obtained through annual structured telephone interviews, were used. All participants had physician-confirmed SLE. The Medical Outcomes Study Sleep Scale was administered in 2010 and used to calculate the 9-item Sleep Problems Index (SPI) score. SPI scores range from 0 – 100; higher scores indicate greater sleep problems. The following PROs were examined: self-reported disease activity (Systemic Lupus Activity Questionnaire; SLAQ); modified SLAQ (mSLAQ) excluding symptoms of depression, fatigue, and forgetfulness; disability (Valued Life Activities, 0 – 3 scale); single item rating of SLE activity (0 – 10 scale); Fatigue (0 – 100 scale); SF36 Bodily Pain scale score (0 – 100 scale); and depressive symptoms (Centers for Epidemiological Studies Depression scale; CESD). Relationships between SPI and PROs were examined concurrently and longitudinally after 2 years using multiple linear regression controlling for age, sex, race, income, education, lupus duration, baseline self-reported disease damage (Brief Index of Lupus Damage; BILD), oral steroid use, smoking, depression, obesity, and physical inactivity. Analyses of all PROs except SLAQ and mSLAQ also included mSLAQ as a covariate. Longitudinal models added the baseline value of the dependent variable.
Results: The sample was 93% female, 61% white non-Hispanic, mean age 53 ±13 years, and mean SLE duration 20 ±9 years. Mean SLAQ in 2010 was 10.9 ± 7.4. The mean SPI in this sample was 44.9 ± 13.7, > one standard deviation higher than the population mean of 25.8 ± 18.61. In cross-sectional analysis, sleep problems were significantly associated with poor outcomes for each PRO (Table 1). Additionally, sleep disturbance was associated with worsening of each PRO over a 2-year period.
Conclusion: Sleep problems appear to be linked to a variety of poor patient-reported outcomes concurrently and to worsening of these outcomes over time. Mechanism for this relationship are not known, but sleep problems have been linked to higher levels of systemic inflammation, greater pain sensitivity, and greater fatigue in the general population. Future studies are needed to characterize sleep problems in SLE objectively, and to identify relationships with clinical outcomes. 1 http://gim.med.ucla.edu/FacultyPages/Hays/surveys/SLEEP/
| Table 1. Association of Medical Outcomes Study Sleep Scale Sleep Problems Index with Patient-reported outcomes, Concurrently and Longitudinally, Adjusted Models1, 2, 3 | ||
|
Concurrent |
2 years later3 |
|
| SLAQ |
2.50 (<.0001)* |
0.68 (<.0001) |
| SLAQ, modified† |
1.92 (<.0001) |
0.50 (.0002) |
| SLE activity (0-10)2 |
0.13 (.04) |
0.19 (0.01) |
| VLA2 |
0.10 (<.0001) |
0.02 (.05) |
| Fatigue 2 |
6.42 (<.0001) |
1.35 (0.02) |
| SF36 Bodily Pain2§ |
1.03 (.0002) |
0.87 (.004) |
| CESD2 |
3.84 (<.0001) |
1.31 (<.0001) |
| * Tabled values are beta per 10-point change in SPI (p-value) from multiple regression analysis. † items querying depressed mood, fatigue, and forgetfulness are excluded from scoring § Score reversed so that higher score reflects greater pain. 1 All analyses control for age, sex, disease duration, income, education, race/ethnicity, oral steroid use (0.5 – 9.5 mg, ≥10 mg), disease organ damage (BILD), obesity, smoking, and physical inactivity 2 Analyses add modified SLAQ as covariate 3 Analyses add baseline value of PRO as covariate Note: Higher scores on all scales reflect worse outcomes. Note: Sleep Problems Index consists of 9 items queries trouble falling asleep, sleep was not quiet, not getting enough sleep, awakening short of breath or with headache, feeling drowsy or sleepy during the day, and trouble staying awake during the day | ||
To cite this abstract in AMA style:
Katz PP, Trupin L, Schmajuk G, Yazdany J, Yelin EH, Criswell LA. Sleep Disturbance Is Associated with Worsening Patient-Reported Outcomes over Two Years in Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/sleep-disturbance-is-associated-with-worsening-patient-reported-outcomes-over-two-years-in-systemic-lupus-erythematosus-sle/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/sleep-disturbance-is-associated-with-worsening-patient-reported-outcomes-over-two-years-in-systemic-lupus-erythematosus-sle/