Self-reported sleep problems are common among patients with psoriatic arthritis (PsA) and have a significant impact on quality of life, according to findings of a systematic review and meta-analysis published in The Journal of Rheumatology.
Researchers summarized the evidence regarding the link between PsA and sleep problems.
They searched PubMed and Embase databases through January 2023 for studies with sleep problems and PsA. The review included those who were 16 years and older and had sleep problems related to their PsA or had a diagnosis of sleep disorders and were evaluated for the incidence or prevalence of PsA. Studies that evaluated the quality of sleep measures in patients with PsA and collected information on the patients’ beliefs about sleep were also included in the analysis.
A total of 36 studies were included in the review (26 cross-sectional, 7 cohort, and 3 interventional) and a meta-analysis was completed on 6 studies that used the Pittsburgh Sleep Quality Index (PSQI).
Researchers found that 30% to 85% of patients with PsA self-reported sleep problems. However, there was a lack of homogeneity in the terminology and instruments used to measure sleep problems. An analysis of 6 studies using the PSQI showed that 72.9% of patients with PsA have poor sleep quality. The percentage was statistically higher among patients with PsA compared with control participants (26.9%), but not significantly different from patients with psoriasis (59.8%). Overall, poor sleep quality was found to be prevalent among patients with PsA.
One study assessing the association between PsA and sleep apnea indicated that a high incidence of patients with PsA had obstructive sleep apnea, which demonstrated a bidirectional association in adjusted models.
Factors that were found to be associated with sleep issues were anxiety, pain, erythrocyte sedimentation rate, emotional recovery, depression, fatigue, physical functioning, and the number of tender or swollen joints.
The use of tumor necrosis factor (TNF) inhibitors, such as guselkumab, and Janus kinase (JAK) inhibitors, such as filgotinib, were found to be linked to improved sleep outcomes.
A limitation of the analysis was that it only included studies published in English.
The study authors concluded, “Longitudinal studies combining daily measurement of PsA signs and symptoms, and subjective and objective sleep measures are needed to further understand how sleep quality relates to PsA disease activity and symptoms.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or universities. Please see the original reference for a full list of authors’ disclosures.
Grant C, Woodbury M, Skougaard M, et al. Sleep problems in patients with psoriatic arthritis: a systematic literature review and meta-analysis. J Rheum. Published online May 1, 2023. doi:10.3899/jrheum.2022-1169