Session Information
Date: Monday, November 6, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Sleep disturbances (SD) are reported to be common in SLE, but relatively few studies have addressed the issue. We examined the frequency and severity of self-reported SD among individuals with SLE and identified predictors of SD.
Methods: Data were from the National Data Bank for Rheumatic Diseases (NDB), for which participants complete questionnaires every 6 months. In one questionnaire, items about the presence of physician-diagnosed obstructive sleep apnea (OSA) and restless-leg syndrome (RLS), use of continuous positive air pressure (CPAP) devices, and symptoms of RLS, as well as the Medical Outcomes Study Sleep Scale (MOS-S) were included. The MOS-S yields 5 subscales; results are shown here only for one (Sleep Problems Index I, SPI-I). Frequencies of reports of OSA, RLS, CPAP use, and RLS symptoms were tabulated. Multivariate regression analyses identified independent predictors of OSA and RLS (logistic regression) and SPI-I scores (linear regression). Potential predictors included age, sex, race, education, smoking, Rheumatic Disease Comorbidity Index (RDCI)1, chronic obstructive pulmonary disease (COPD), asthma, meeting fibromyalgia criteria, obesity (BMI ≥ 30 kg/m2), disease duration, pain, prednisone and other medication use, and disease activity (Systemic Lupus Activity Questionnaire, SLAQ2) and damage (Brief Index of Lupus Damage, BILD3).
Results: Subject characteristics are shown in Table 1 (n = 385). 24% reported physician-diagnosed OSA and 20% RLS, compared to ~2-4% and ~10%, respectively, in the general population. 14% used CPAP, and 33% had RLS symptoms. Mean SPI-I was 36.0 (±34.1), ~0.5 standard deviation higher than a population sample mean. Independent predictors of OSA were greater age, obesity, asthma, RDCI, and disease activity (Table 2). Predictors of RLS were RDCI and disease activity. Worse scores on SPI-I were associated with younger age, non-white race, higher RDCI, and greater pain and disease activity.
Conclusion: Both OSA and RLS were more common in SLE than in the population; SPI-I scores were also worse. Some predictors of SDs were similar to predictors in the population (age, obesity), but disease activity was also associated with SD. Research in SLE has linked SDs to worse outcomes. Previous research in other conditions suggests that SDs might also be a cause of increased disease activity through heighted inflammation. Further research is needed to tease out disease-specific causes and effects of SD in SLE.
1 England BR. Arthritis Care Res 2015; 6: 865
2 Karlson EW. Lupus 2003; 12:280.
3 Yazdany J. Arthritis Care Res 2011; 63:1170
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Table 1. Subject characteristics (n = 385) |
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Mean ± SD or % (n) |
Mean ± SD or % (n) |
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|
Age, years |
60.9 ± 12.4 |
SLE duration, years |
25.7±12.6 |
|
Female |
94.0 (362) |
Pain rating (0 – 10) |
4.0 ± 2.9 |
|
White |
84.9 (327) |
SLAQ (0 – 46) |
11.1 ± 7.6 |
|
Current smoker |
3.4 (13) |
BILD (0 – 12) |
3.7 ± 2.3 |
|
Obese (BMI≥30) |
34.6 (133) |
Fibromyalgia |
26.8 (88) |
|
Asthma |
13.3 (50) |
Prednisone use |
34.5 (146) |
|
COPD |
7.0 (27) |
Mean prednisone dose (mgs) |
6.8 ± 6.1 |
|
RDCI (0 – 9) |
2.7 ± 1.9 |
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Table 2. Significant independent predictors of sleep disturbances |
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Obstructive Sleep Apnea (OSA)* |
Restless Leg Syndrome (RLS)* |
Sleep Problems Index I (SPI-I)† |
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|
Age |
1.05 (1.01, 1.09) |
(ns) |
-0.22 (.01) |
|
White race |
(ns) |
(ns) |
-6.3 (.02) |
|
Obesity |
5.3 (2.6, 10.8) |
(ns) |
(ns) |
|
Asthma |
2.7 (1.04, 7.0) |
(ns) |
(ns) |
|
RDCI |
1.3 (1.1, 1.6) |
1.2 (1.05, 1.5) |
1.15 (.03) |
|
Pain rating |
(ns) |
(ns) |
2.0 (<.0001) |
|
SLAQ |
1.07 (1.01, 1.13) |
1.1 (1.01, 1.04) |
0.7 (.0002) |
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* Tabled values are odds ratio (95% CI) from multiple logistic regression analyses † Tabled values are beta (p-value) from multiple linear regression analysis. Higher scores reflect greater sleep problems |
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To cite this abstract in AMA style:
Katz PP, Pedro S, Michaud K. Sleep Disturbances in Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/sleep-disturbances-in-systemic-lupus-erythematosus-sle/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/sleep-disturbances-in-systemic-lupus-erythematosus-sle/