Background/Purpose: Poor sleep quality is a frequent concern among patients with systemic lupus erythematosus (SLE) and contributes to fatigue and other comorbidities. This study investigates the prevalence of poor sleep quality among patients with SLE and the relationship between sleep quality and SLE-related medication use.

Methods: Patients with SLE participating in a longitudinal observational study at a single academic center were invited by email to complete a web-based sleep questionnaire and medication inventory. The Pittsburg Sleep Quality Index (PSQI), a self-reported validated questionnaire ascertaining sleep habits over the past month, was the metric chosen for measuring sleep quality and was scored using the PSQI scoring algorithm. Demographics, medical history including classification criteria for SLE and SLE disease damage scores were obtained from the existing research registry for each participant.  Pearson’s chi-squared testing was performed for categorical measures and two-sample t-tests were performed for continuous measures. Significance was set at alpha = 0.05.

Results: Of the 142 patients that completed the Pittsburg Sleep Quality Index (PSQI), 99% were female and 86% were African American. The mean PSQI score was 11.98 +/- sd 3.63 with a minimum score of 4 and maximum of 20 out of a possible 21. Higher PSQI scores (corresponding to worse sleep quality) were significantly associated with getting less than 7 hours of sleep (p< 0.01), taking sleep medications at least weekly (p< 0.01), and having a diagnosis of obstructive sleep apnea (p< 0.01), but there was no significant difference found between patients based on age, race, history of lupus nephritis or accumulated disease damage by SLICC-DI.  Having a poor PSQI score was not associated with prednisone dose (p= 0.09), however taking greater than 7mg of prednisone daily was inversely correlated to the number of hours patients slept per night (p< 0.01).  Mean number of hours per sleep per night was 5.7 +/- sd 1.5, despite a mean of 8.0 +/- sd 2.0 hours spent in bed.  42.3% of patients reported taking medications for sleep at least once a week.

Conclusion: In this study of patients with SLE, we found a high prevalence of poor quality sleep and a mean of less than 6 hours of sleep/24 hours despite an average of 2 additional hours spent in bed. Although we did not find SLE-specific predictors of poor sleep quality, the overall sleep habits of the patients reflect a critical need to address sleep with patients and work toward interventions for improvement of sleep quality.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sleep-quality-among-patients-with-systemic-lupus-erythematosus/