AB0709 Sleep disturbances and rheumatic diseases – a case-controlled cross-sectional study

Abstract

BackgroundRheumatic diseases may affect all aspects of life, including sleep1. Sleep disorders are common and potentially debilitating in these diseases, and the reason for this disturbance seems to be multifactorial.ObjectivesEvaluate the prevalence of sleep disturbance and its association with demographic-clinical factors in patients with Systemic Sclerosis (SSc) and Rheumatoid Arthritis (RA).MethodsWe conducted a cross-sectional study on patients, aged ≥18, who fulfilled the ACR/EULAR 2013 classification criteria for SSc and ACR/EULAR 2010 classification criteria for RA. Socio-demographic and clinical data was collected. Patients answered the Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale and Pittsburgh Sleep Quality Index (PSQI) questionnaires. Sleep disorders were considered when PSQI was >52. Differences between groups were assessed and variables with statistical significance in the univariate analysis were included in a multivariate logistic regression model, adjusted to age and sex. p ≤ 0.05 was considered significant in all analysis.ResultsFifty-six patients (28 with SSc and 28 with RA) agreed to participate in this study, of which 47 (83.9%) were female, with a median age of 61 years old (IQR 14). Most of our patients (73.2%) had a sleep disturbance, fatigue (80.4%) and disability (89.3%). Twenty patients (35.7%) suffered from anxiety and 10 (17.9%) from depression. A statistically significant association was found between sleep disturbances and the disease, its duration and body mass index (BMI). FACIT, HAQ and HADS-A, but not with HADS-D, were also associated (Table 1). When comparing diseases, there was no differences between gender, age, and BMI, however duration of disease was superior in RA patients (p<0.001) (Table 1). On the other hand, the SSc group showed worse mean scores in HAQ and PSQI compared with RA group (Table 1). Though, sleep disturbance was not associated with any clinical feature of SSc. Although SSc [3.882 (1.056-14.276), p=0.041], FACIT [0.883 (0.812-0.960), p=0.004], HAQ [4.223 (1.204-14.818), p=0.024] and HADS-A [1.257 (1.057-1.495), p=0.010] were predictors of sleep disorder in the univariate analysis, their effect disappeared in the multivariate logistic model.Table 1.Differences between sleep disorders and between Systemic Sclerosis and Rheumatoid ArthritisCharacteristicsWithout sleep disorder(n=15)Sleep disorder(n=41)P valueSSc group(n=28)RA group(n=28)P valueAge (year)Median (IQR)55 (16)61.50 (13)0.05960.50 (14)61 (15)0.941Female genderN (%)13 (86.7%)34 (82.9%)0.73624 (85.7%)23 (82.1%)0.716Disease duration (months)Median (IQR)144.00 (156.00)66.00 (60.00)0.007*60 (60)120 (126)<0.001*BMIMedian (IQR)22.51 (6.47)27.26 (6.95)0.05427.26 (7.92)24.65 (6.06)0.440FACITMedian (IQR)40.50 (12.25)31.50 (18.00)0.001*33.00 (22.75)36.00 (12.50)0.522HAQMedian (IQR)0.438 (0.563)0.813 (1.50)0.022*0.875 (1.625)0.500 (0.563)0.037*HADS-AMedian (IQR)6.50 (5.50)10.00 (5.00)0.008*9.50 (5.00)8.00 (7.50)0.229HADS-DMedian (IQR)6.50 (5.00)7.50 (5.00)0.1008.00 (4.75)6.00 (5.00)0.105PSQIMedian (IQR)12.00 (7.25)7.00 (7.50)0.021*Sleep disorderN (%)24 (85.7%)17 (60.7%)0.035*Legend: IQR - Interquartile Range.ConclusionIn our cohort, sleep disturbances were highly prevalent, and we found a significant association between those and SSc, FACIT, HAQ and HADS-A. However, we didn’t find a predictor of this disturbance in the multivariate analysis. New studies with large number of patients are warranted.