Background/Purpose: Sleep disturbances, including difficulty initiating sleep, maintaining sleep, and/or early morningawakenings are prevalent in persons with rheumatoid arthritis (RA) and can significantly impact quality of life and worsening of other RA symptoms including fatigue and pain. Despite their high prevalence and negative consequences, sleep disturbances remain poorly understood and inadequately managed in persons with RA.  This study aimed to characterize sleep disturbances in RA and identify the role of disease-related, lifestyle behaviors and depressive symptoms in relation to sleep quality in women with RA.

Methods: We conducted a cross-sectional study using 2018 data from an annual survey administered to an RA cohort derived from a population-based cohort from British Columbia. The sample was comprised of 146 women with RA (mean age = 73.7 years ± 10.9). Participants completed self-report questionnaires assessing sociodemographics, anthropometrics, disease activity, functional impairment, leisure time physical activity, alcohol consumption, smoking and depressive symptoms. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics were performed to characterize the sleep parameters. Bivariate associations with the potential determinants of poorer sleep (PSQI global score) were first calculated, followed by multivariate linear regression with variables found to be significantly associated with sleep in the bivariate analyses.

Results: The mean global PSQI score was 8.1 (SD=4.1), with 70.5% of the sample classified as poor sleepers (PSQI global score >5). Sleep latency was greater than 30 minutes in 24% of the sample and 35% reported sleep duration < 7 hours. A sleep efficiency of less than 75% was reported by 26% of the sample. Awakening at night three or more times a week was reported by 62.8% of the patients, and this was most commonly attributed in part due to requiring use of the washroom (80.7% ) and pain (60.7%). Of the total participants, 44.5% reported using medication to aid sleep in the past month, with 31.5% using sleep medication 3 or more times per week. Significant bivariate relationships with sleep quality are shown in the Table. Age, education, obesity, disease duration, menopausal status, and smoking were not associated with sleep quality. In the multivariate analysis, disease activity and depressive symptoms remained independently associated with poorer sleep quality.

Conclusion: Sleep problems are prevalent among patients with RA.  Our findings suggest that in addition to disease activity, depressed mood contributes to poor sleep in RA. Multimodal interventions which include nonpharmacological methods to target sleep require evaluation to optimize the management of sleep disruptions in RA.

Table 1 ACR

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sleep-quality-in-women-with-rheumatoid-arthritis-is-associated-with-disease-activity-and-depressive-symptoms/