Sleep disturbances in chronic rheumatic diseases: Is disease activity the major determinant factor?
##plugins.themes.academic_pro.article.main##
Abstract
Abstract
Sleep disturbances are closely related to chronic pain processes, especially in patients with inflammatory and mechanical joint diseases.
Objectives: This study aims to report sleep characteristics in patients with rheumatoid arthritis (RA) and knee osteoarthritis also to determine the responsibility of disease activity in the occurrence of sleep disturbances during chronic rheumatic diseases.
Methods: We conducted a comparative study between two groups of patients: the first with RA, the second with primary knee osteoarthritis. We reported sociodemographic and medical data (clinical and biological inflammatory syndrome data). Then, we assessed depression, anxiety, and sleep disturbances with respectively Beck Depression Inventory, Beck Anxiety Inventory and Medical Outcome Study Sleep Scale (MOS-SS).
Results: Seventy RA patients aged 51.9 years, with an average of 77.1% female were studied. The mean disease duration was 6.9 years. All sleep domains were altered in these patients. Forty patients with knee osteoarthritis aged 57.5 years with an average of 70% female were included. The mean disease duration was 4 years. The most impaired domains in this group were somnolence and sleep disturbance. Multivariate analysis concluded that risk factors independently related to RA were: disease activity score, functional disability, depression, anxiety, and body mass index. Disease activity score were the only parameter to influence all domains of sleep.
Conclusion: So we result that disease activity is a risk factor independently related to sleep disturbances in rheumatoid arthritis. Furthermore, mood disorders and obesity also deteriorate several sleep domains. These factors must be considered in the management of chronic rheumatic disorders.
Keywords:
Sleep; rheumatoid arthritis; osteoarthritis; inflammation; depression; anxiety.##plugins.themes.academic_pro.article.details##
References
- 1- Beunaver LF, Smith MT. Sleep in rheumatic diseases and other painful conditions. Curr treat options Neurol. 2007;9:325-36. 2- Moldofsky H. Sleep and pain. Sleep Med Rev. 2001;5:387-98. 3- Abad VC, Sarinas P, Guilleminault C. Sleep and rheumatologic disorders. Sleep Med Rev. 2008;12:211-28. 4- O'Brien EM, Waxenberg LB, Atchison JW, Gremillion HA, Staud RM, McCrae CS et al. Negative mood mediates the effect of poor sleep on pain among chronic pain patients. Clin J Pain. 2010;26:310-9. 5- Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D et al. Development of a fatigue scale. J psychosom res. 1993;37:147-53. 6- Williams DA, Arnold LM. Measures Applied to the Assessment of Fibromyalgia. Arthritis Care Res. 2011;63:86-97. 7- Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;(3):315-24. 8- Prevoo ML, van't Hof MA, Kuper HH. Modified disease activity scores that include twenty- eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44-8. 9- Bruce B, Fries JF. The Stanford Health Assessment Questionnaire: Dimensions and Practical Applications. Health Qual Life Outcomes. 2003;1:20. 10- Van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol. 1999;26:743-5. 11- Lequesne MG. The algofunctional indices for hip and knee osteoarthritis. J Rheumatol. 1997;24:779-81. 12- Kellgren JH, Lawrence JS. Radiologic assessment of osteoarthritis. Ann Rheum Dis. 1987;16:494-501. 13- Beck AT, Beamesderfer A. Assessment of depression: the depression inventory. Mod Probl Pharmacopsychiatr. 1974;7:151-69 14- Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-5. 15- Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56:893-7. 16- Solak O, Fidan F, Dundar U, Türel A, Ayçiçek A, Kavuncu V et al. The prevalence of obstructive sleep apnoea syndrome in ankylosing spondylitis patients. Rheumatology. 2009;48:433-5. 17- Hays R., and Stewart A.: Sleep measures. In Stewart A., and Ware J. (eds): Measuring functioning and well-being approach: the medical outcomes study. Durham, NC: Duke University Press, 1992. 18- Gudbjornsson B, Broman JE, Hetta J, Hallgren R. Sleep disturbances in patients with primary Sjogren's syndrome. Br J Rheumatol. 1993;32:1072-6. 19- Chandrasekhara PK, Jayachandran NV, Rajasekhar L, Thomas J, Narsimulu G. The prevalence and associations of sleep disturbances in patients with systemic lupus erythematosus. Mod Rheumatol. 2009;19:407-15. 20- Wolfe F, Michaud K, Li T. Sleep disturbance in patients with rheumatoid arthritis: Evaluationby medical outcomes study and visual analog sleep scale. J Rheumatol. 2006;33:1942-51. 21- Houssien DA, McKenna SP, Scott DL. The Nottingham Health Profile as a measure of disease activity and outcome in rheumatoid arthritis. Br J Rheumatol. 1997;36:69-73. 22- Bourguignon C, Labyak SE, Taibi D. Investigating sleep disturbances in adults with rheumatoid arthritis. Holist Nurs Pract. 2003;17:241-9. 23- Sariyildiz MA, Batmaz I, Bozkurt M, Bez Y, Cetincakmak MG, Yazmalar L et al. Sleep Quality in Rheumatoid Arthritis: Relationship Between the Disease Severity, Depression, Functional Status and the Quality of Life. J Clin Med Res. 2014;6:44-52. 24- Hakkou J, Rostom S, Mengat M, Aissaoui N, Bahiri R, Hajjaj Hassouni N. Sleep disturbance in Moroccan patients with ankylosing spondylitis: Prevalence and relationships with disease specific variables, psychological status and quality of life. Rheumatol int. 2013;33:285-90. 25- Katz PP, Yelin EH. Activity loss and the onset of depressive symptoms: do some activities matter more than others?. Arthritis Rheum. 2001;44:1194-202. 26- El Bouchti I, Amine M , El Hassani S . Les troubles du sommeil au cours de la polyarthrite rhumatoïde. Rev Mar Rhum. 2012;20:52-5. 27- Murphy SL, Lyden AK, Phillips K, Clauw DJ, Williams DA. Subgroups of older adults with osteoarthritis based upon differing comorbid symptom presentations and potential underlying pain mechanisms. Arthritis Research Ther. 2011;13:135. 28- Shin MH, Kweon SS, Choi BY, Kim MK, Chun BY, Shin DH et al. Self-reported snoring and metabolic syndrome: the Korean Multi-Rural Communities Cohort Study. Sleep Breath. 2014;18:423-30. 29- Coskun-Benlidayi I. Sleep impairment: an obstacle to achieve optimal quality of life in rheumatoid arthritis. Rheumatol Int. 2018; 38(12):2183-92. 30- Cutolo M. Circadian rhythms and rheumatoid arthritis. Joint Bone Spine. 2019; 86(3):327-33. 31- Drewes AM, Nielsen KD, Hansen B, Taagholt SJ, Bjerregârd K, Svendsen L. A longitudinal study of clinical symptoms and sleep parameters in rheumatoid arthritis. Rheumatology. 2000;39:1287-9. 32- Mahowald MW, Mahowald ML, Bundlie SR, Ytterberg SR. Sleep fragmentation in rheumatoid arthritis. Arthritis Rheum. 1989;32:974-83.