Background/Purpose: Systemic Sclerosis (SSc) is an autoimmune connective tissue disorder characterized by thickening and fibrosis of the skin and internal organs. There is significant mortality and morbidity in SSc, considerable functional disability, and no known cure. Therefore, appropriate symptom management is critical in improving patient quality of life. SSc patients experience numerous problems contributing to reduced quality of life, including fatigue, pain, depression, sexual dysfunction, body image distress, and itching. In SSc, as well as other rheumatic diseases, sleep disturbances also appear to be common. However, to date, there has been very little research in this area. In fact, only 3 relatively small studies have investigated sleep disturbance in SSc. This study’s objective was therefore to investigate the association of factors potentially associated with sleep disturbance in the general population (gender, age, marital status, education, income, current medications, and medical diagnoses), in SSc (shortness of breath, gastrointestinal symptoms, pain, and pruritus), and across rheumatic diseases (pain) with sleep disturbance in a large Canadian sample of SSc patients.

Methods: The sample included patients enrolled in the Canadian Scleroderma Research Group’s (CSRG) 15-center, pan-Canadian Registry. To be eligible for the Registry, patients must have a diagnosis of SSc, be >18 years of age, and be fluent in English or French. Pearson correlations were used to assess bivariate associations of sociodemographic and medical variables with PROMIS sleep disturbance scores (range 8-40). Multivariate linear regression was used to assess the association of factors associated with sleep disturbance in the general population, in SSc, and across rheumatic diseases with PROMIS sleep disturbance scores.

Results: There were 397 patients in the study. The mean (SD) sleep disturbance score was 22.8 (8.0). More gastrointestinal (GI) symptoms (standardized β = 0.19, p = 0.001), pain severity (standardized β = 0.21, p < 0.001), and pruritus severity (standardized β = 0.13, p = 0.024) were associated with more severe sleep disturbance in multivariate regression. 

Conclusion: The number of GI symptoms, pain severity, and pruritus severity are medical factors that are associated with increased sleep disturbance in SSc. This is consistent with previous studies that identified GI involvement and pain as independent predictors of sleep disturbance in SSc. Previous studies did not include pruritus, however. This is the first study to do so and findings support the need for further research into pruritus, as well as possible interactions between the itch- and pain-processing pathways of the neuronal system. Important sociodemographic and medical factors related to sleep disturbance in the general population were also investigated. However, none of these factors were related to sleep disturbance in SSc, possibly because of the strong influence of disease-specific factors. Overall, better management of GI symptoms, pain, and pruritus, which are key medical factors in SSc, may have important ramifications for quality of life in SSc, including sleep quality.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sleep-disturbances-in-systemic-sclerosis-evidence-for-the-role-of-gastrointestinal-symptoms-pain-and-pruritus/