ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1532

Sleep Hygiene Practices and Associations with Patient-Reported Outcomes in Rheumatoid Arthritis

Sapna Sangani1 and Joshua F. Baker1,2, 1Rheumatology, University of Pennsylvania, Philadelphia, PA, 2Medicine/Rheumatology, University of Pennsylvania and Philadelphia VAMC, Philadelphia, PA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Monday, November 14, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster II: Co-morbidities and Complications

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Previous studies showed a high prevalence of sleep disturbances in Rheumatoid Arthritis (RA). Poor sleep has been associated with patient-reported outcomes (PROs) for measuring disease activity in RA. Sleep hygiene is a variety of behavioral practices important for normal, quality nighttime sleep. The relationship between sleep hygiene behaviors themselves and PROs has not been described. We evaluated associations between sleep hygiene, sleep quality, and PROs in veterans with RA.

Methods: This is a cross-sectional study of patients with RA attending a single VA rheumatology clinic. Participants were administered 3 questionnaires by telephone survey:  1) Sleep Hygiene Index (SHI), 2) Pittsburgh Sleep Quality Index (PSQI), and 3) RAPID3 (comprising the Multi-dimensional Health Assessment Questionnaire [MD-HAQ], pain and, patient global scores [0-10]). Furthermore, information about demographics, BMI, inflammatory markers within the past 6 months, RA serologies, medications, and comorbid diagnoses were collected by chart review. Correlations between sleep hygiene, sleep quality, and PRO’s were performed using Spearman’s correlations and linear regression analyses.

Results: The cohort consisted of 51 subjects (86% male, mean age of 63 (range 27-77), mean BMI of 28.7, 84% seropositive). The mean SHI score was 17 (6.3) and mean PSQI score was 9.23 (4.0). Only 11/51 (22%) patients had normal sleep quality (PSQI <5 units). The SHI was strongly associated with PSQI (Rho: 0.40, p = 0.004). Both SHI and PSQI were strongly correlated with all RA PROs (Table, Figure). Question 8 from the SHI, “I go to bed feeling stressed, angry, upset, or nervous” was particularly associated with PROs. Specific domains of the PSQI associated with the PROs included subjective sleep quality, habitual sleep efficiency, sleep disturbances, and daytime dysfunction. PSQI total score and SHI total score were significantly higher among those with comorbid depression, but similar among those with osteoarthritis (p>0.78). RAPID3 correlated with SHI and PSQI, but was not associated with ESR. In multivariable models adjusting for age, gender, and depression SHI was independently associated with RAPID3.

Conclusion: Sleep hygiene behaviors and sleep quality play an important role in a patient’s experience of their RA and correlate with self-report of function, pain, and well-being. Sleep hygiene questions that assessed patient distress at night were most strongly associated with these PROs. This study emphasizes how sleep and sleep behavior might impact the patient reporting of disease activity.

                   

Table 1: Spearman’s correlation between PROs and sleep hygiene and sleep quality indices (n = 51).

Variable

RAPID 3

Pain

Patient Global Status Functional Status

Sleep Hygiene Total Score

0.38*

0.31*

0.34*

0.43*

Sleep Quality Total score

0.56*

0.38*

0.63*

0.56*

Sleep Hygiene Questions

 

 

 

 

SHI Question 1

0.25

0.30*

0.15

0.16

SHI Question 8

0.49*

0.46*

0.47*

0.48*

SHI Question 13

0.28*

0.36*

0.17

0.33*

PSQI components

 

 

 

 

Subjective Sleep Quality

0.71*

0.56*

0.76*

0.60*

Sleep Duration

0.31*

0.25

0.29*

0.27

Habitual Sleep Efficiency

0.48*

0.37*

0.57*

0.43*

Sleep Disturbances

0.43*

0.44*

0.36*

0.38*

Daytime Dysfunction

0.43*

0.37*

0.43*

0.45*

ESR (n = 41)

0.17

0.17

0.13

0.17

*p<0.05
SHI Question 1: “I take daytime naps lasting two or more hours.” SHI Question 8: “I go to bed feeling stressed, angry, upset, or nervous.” SHI Question 13: “I think, plan, or worry when I am in bed.”

 

Disclosure: S. Sangani, None; J. F. Baker, None.

To cite this abstract in AMA style:

Sangani S, Baker JF. Sleep Hygiene Practices and Associations with Patient-Reported Outcomes in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/sleep-hygiene-practices-and-associations-with-patient-reported-outcomes-in-rheumatoid-arthritis/. Accessed .

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