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A significant percentage of patients with rheumatoid arthritis (RA) met the criteria for sleep disorders, including obstructive sleep apnea (OSA), restless legs syndrome (RLS), and short sleep, according to results of a study published in Arthritis Care & Research (Hoboken). In addition, RA disease activity and pain were also found to be linked to the sleep conditions.
Although poor sleep is often reported among patients with RA and can be associated with significant health implications, little research has focused on the prevalence of specific sleep disorders in individuals with RA.
In the current study, researchers used data from the ongoing US observational, longitudinal study FORWARD, The National Databank for Rheumatic Diseases. Participants in the registry were mainly enrolled based on diagnoses provided by the physician. Data were collected at 6-month intervals using questionnaires.
All participants with physician-confirmed RA who completed the July 2016 comprehensive sleep questionnaire were enrolled in the analysis.
Short sleep was determined based on patients’ self-reported average sleep time (ie, <6 hours). Self-reported sleep quality was evaluated using the Medical Outcomes Study Sleep Problems Index I. Multivariable logistic regression models identified independent predictors of sleep disorders and sleep quality, as well as the independent association of risk for OSA, RLS symptoms, and short sleep with participants’ self-reported poor sleep quality.
A total of 4200 individuals (83.7% women; 92.5% White) with RA were included in the study. The mean patient age was 64.6 years. Approximately one-thirds of participants were considered overweight and one-thirds had obesity, based on standard body mass index (BMI) criteria. Approximately 40% of the participants were ever-smokers and 3.6% were current smokers.
The most common comorbidities included hypertension, asthma, depression, and history of cerebrovascular accident or myocardial infarction. The mean disease duration was 21.1 years. The mean Rheumatoid Arthritis Disease Activity Index (RADAI) score was low (2.4±1.6). Two-thirds of the cohort reported current use of a conventional disease-modifying antirheumatic drug (DMARD); one-thirds reported use of a tumor necrosis factor (TNF) inhibitor; and 12% reported use of abatacept. Approximately one-quarter of patients reported glucocorticoid use, with high-dose use reported in approximately 7%.
Results of the study also showed that 21% of participants had a diagnosis or risk for OSA; 30% had a diagnosis or symptoms of RLS; and 43% reported having short sleep. The presence of RA disease activity was associated with each of the sleep disorders. Abatacept therapy was associated with a lower risk for RLS and short sleep. Further, the use of conventional DMARDs or abatacept was less common among those with short sleep. According to the multivariable analysis, none of the medications compared were associated with OSA. In addition, both RLS and short sleep were linked to worse perceived sleep quality.
Nearly two-thirds of the participants fulfilled criteria for at least 1 sleep disorder, with both RA disease activity (as per the RADAI score) and pain being significantly associated with each of the sleep conditions (P <.0001 for both).
With regard to study limitations, the estimated prevalence of sleep disorders may have been affected because the sample was skewed toward older patients and that fact that more than 90% of the participants were White, with a large percentage of them being college-educated.
The researchers concluded that “Additional research is needed to tease out the causal pathway for associations noted between sleep disorders and RA disease activity and pain, as well as to identify the long-term consequences of sleep disorders in [patients with] RA.”
Reference
Katz P, Pedro S, Michaud K. Sleep disorders among individuals with rheumatoid arthritis. Arthritis Care Res (Hoboken). Published online August 23, 2022. doi:10.1002/acr.24999
