Abstract
The prevalence of symptomatic insomnia and the prevalence of restless legs syndrome (RLS) are known to be higher among patients with rheumatic diseases compared to the general population. The prevalences of insomnia and RLS reported in a questionnaire by Japanese patients with rheumatic diseases at an outpatient clinic were analyzed herein. The association between the patients' disease activity and their sleep quality was analyzed. Of 121 rheumatic disease patients, 70 were enrolled. The median (interquartile range) age at enrollment was 62.0 (47.8-68.0) years. There were 58 women (82.9%) and 12 men (17.1%), and 43 patients (61.4%) with rheumatoid arthritis (RA), nine (12.9%) with systemic lupus erythematosus (SLE), and 18 (25.7%) with other rheumatic diseases. Twenty patients (28.6%) had one or more moderate-to-severe insomnia symptoms, and 10 (14.3%) were diagnosed with RLS. Among the patients with RA, the swollen joint count based on a 28-joint assessment (SJC28) was significantly higher in the insomnia group (n = 13) compared to the non-insomnia group (n = 30) (p = 0.006). A classification and regression tree (CART) analysis showed that the cut-off points of ≥3 mg/day prednisolone (PSL) treatment and <16.54% as the transferrin saturation (TSAT) value would best predict RLS in rheumatic disease. Patients with rheumatic disease had a high prevalence of symptomatic insomnia and RLS. A higher dose of PSL and lower TSAT were associated with the occurrence of RLS.
Highlights
MethodsWe collected 121 consecutive patients with rheumatic disease treated between August 2017 and May 2018 at the outpatient clinic at Nagasaki University Hospital
The rheumatic diseases are a diverse group of chronic diseases characterized by the presence of chronic inflammation affecting structures of the musculoskeletal system, blood vessels, and other tissues
The results of our analyses indicated that insomnia is a consequence of joint pain in patients with rheumatoid arthritis (RA), and chronic joint pain may result in a vicious cycle in which sleep disturbance activates clinical symptoms of pain, which contribute to further sleep loss
Summary
We collected 121 consecutive patients with rheumatic disease treated between August 2017 and May 2018 at the outpatient clinic at Nagasaki University Hospital. The quality of the studies was assessed on the basis of elements from the STROBE checklist for cross-sectional studies [19]. The eligibility criteria for patients participating in this study were: (1) having a clinical diagnosis of RA, systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), systemic sclerosis, vasculitis, osteoarthritis, dermatomyositis, or spondyloarthritis by a rheumatologist; (2) a current user of at least prednisolone or an immunosuppressant according to their medical records; (3) >20 years old, and 4) able to provide informed consent. Patients who declined to provide informed consent to participate in the study were excluded. The study was reviewed and approved by the Medical Ethical Committee of Nagasaki University Hospital The study was reviewed and approved by the Medical Ethical Committee of Nagasaki University Hospital (approval no. 16092619)
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