Gastroesophageal Reflux Disease in Scleroderma: Effects on Sleep Quality, Fatigue, and Quality of Life

Abstract

Introduction: Systemic Scleroderma/Sclerosis (SSc) can cause extensive fibrosis of smooth muscle within the muscularis propria impairing neuromuscular function leading to esophageal motor dysfunction and gastroesophageal reflux disease (GERD), which is the most common visceral complaint. Nocturnal GERD may be associated with sleep disturbances, which in turn can drastically affect quality of life. We hypothesized that GERD symptoms would be associated with poorer sleep and quality of life in patients with SSc. Methods: Rheumatologist established SSc patients completed the following questionnaires: the Pittsburgh Sleep Quality Index (PSQI) consisting of seven components and a total score that assesses sleep quality; the UCLA SCTC GIT 2.0 Questionnaire, which assesses GI symptoms and emotional/social well-being, including eight specific questions regarding reflux and frequency of symptoms; and the Fatigue Severity Scale. Poor sleep quality was defined by a PSQI total score > 5. Overnight pulse oximetry data was also collected on a subset of patients. Data are presented as mean (SD) or n (%) and significance levels were set at P < 0.05. Results: Questionnaires were completed by 275 (age=60 (14) yrs; female=237). Abnormal PSQI scores indicating poor sleep quality was identified in 182 (66.2%) patients. Patients with poor sleep quality reported less sleep time (7.7 h vs 6.4 h; P < 0.001) and increased fatigue compared to SSc patients with normal sleep scores. GERD was more prevalent in SSc patients and the GIT Reflux score was significantly higher in patients with abnormal PSQI scores (p < 0.001). Patients with poor sleep quality reported increased interference with social activities and emotional wellbeing, as well as fatigue (p < 0.001). Narcotic and antidepressant use was significantly more frequent in SSc patients with abnormal PSQI scores. Multivariable logistic regression supported the association between GERD symptoms and disturbed sleep after controlling for age, sex, and BMI (2.53, 95% CI 1.52-4.25; p < 0.001). The association remained after controlling for narcotic and antidepressant use (2.20, 95% CI 1.29 - 3.73; P < 0.001). Conclusion: SSc patients who reported GERD symptoms were also more likely to report poor sleep quality, difficulty with social functioning, and disturbances in emotional well-being. We found these patients also used more pharmacologic treatment for pain and depression. Limitations of our study include possibility of recall bias on questionnaires.Table 11