Insomnia and reduced quality of life are symptoms of abnormal sleep behavior common among patients with spondyloarthritides (SpA), especially among women, according to study findings published in Rheumatic & Musculoskeletal Diseases Open.
Investigators analyzed quality of sleep and health-related quality of life (HRQOL) among patients with SpA and assessed factors that may be associated with sleep disturbances.
A retrospective cross-sectional review was conducted including 330 patients, 168 diagnosed with psoriatic arthritis (PsA) and 162 diagnosed with axial spondyloarthritis (axSpA).
Surveys were used to assess sleep behavior (Regensburg Insomnia Scale), quality of life (World Health Organization Quality of Life questionnaire), mental health and depression (Patient health questionnaire 9 and Beck Depression Inventory II), and functional impairment (Funktionsfragebogen Hannover questionnaire).
Of the 330 patients included in the analysis, 44.5% were women. Mean age among patients with PsA vs axSpA was 57.4 vs 49.0 years, respectively.
No significant differences were noted in occurrence of enthesitis(P =.305) or disease duration (P =.343) between patients with PsA (duration, 10.8 years) vs axSpA (duration, 11.8 years).
Patients in the axSpA group had 100% axial involvement, while involvement occurred among 34.7% of patients with PsA. Peripheral arthritis was present among 69.4% and 96.4% of patients with axSpA and PsA, respectively.
Significant functional impairment (defined as functional capacity <60%) was noted among 20.2% of patients with PsA and 13.7% of patients with axSpA.
Investigators found almost half (46.6%) of patients with SpA reported abnormal sleep behavior.
Insomnia symptoms among patients with axSpA were associated with human leukocyte antigen B27 positivity, depressive symptoms, functional capacity, disease duration, and Bath Ankylosing Spondylitis Disease Activity Index.
Insomnia symptoms among patients with PsA were associated with depressive symptoms, female sex, and Disease Activity Score 28.
Patients with axSpA vs PsA more frequently reported waking up too early (P =.038). There were no other significant differences related to sleep behavior between groups.
Overall, patients with axial involvement more frequently reported waking up too early (P =.016), feeling unrefreshed in the morning (P =.006), and more symptoms of insomnia (P =.002) vs patients without axial involvement.
Significantly more depressive symptoms (P <.001) and reduced mental and physical HRQOL (P <.001) were associated with unrestful sleep. Additionally, poor sleep was reported to be a burden on general well-being, as indicated by patients’ reduced satisfaction with health (all P <.001).
Overall, women were associated with significantly worse sleep quality compared with men, reporting increased sleep disturbances (P =.014) and unrestful sleep (P <.001), reduced physical (P =.015) and mental (P <.001) HRQOL of life, prolonged sleep latency (P =.009), and more depressive symptoms (P =.015).
This study was limited by its retrospective design.
The study authors concluded, “Non-pharmacological interventions to improve sleep may include patient education about sleep hygiene, exercise such as physical therapy and balneotherapy, bright-light therapy and cognitive behavioural therapy techniques. Improving sleep may also have beneficial synergistic effects on functional status and pain.”
Disclosure: This research was supported by Novartis Pharma GmbH, Germany. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Frede N, Rieger E, Lorenzetti R, et al. Sleep behavior differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms. RMD Open. Published online May 19, 2023. doi:10.1136/rmdopen-2022-002912