Sleep problems are of higher priority for improvement for patients with ankylosing spondylitis than for patients with other inflammatory arthropathies

1Department for Research and Development, Oslo University Hospital, Ullevål, Oslo, Norway.
Annals of the rheumatic diseases (Impact Factor: 10.38). 11/2010; 70(5):872-3. DOI: 10.1136/ard.2010.133793
Source: PubMed
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    ABSTRACT: Sleep problems are common in persons living with spondyloathropathy (SpA). Approximately 55%Á66% of individuals living with SpA report poor sleep quality, characterized mainly by difficulties initiating and/or maintaining sleep. Emerging data also indicate that sleep and respiratory disorders are prevalent in patients with SpA. Despite their prevalence and potential to negatively impact health and quality of life, sleep problems remain underrecognized, undertreated, and understudied in this patient population. Only a handful of studies have been conducted to investigate determinants of sleep problems in SpA. The findings suggest that disease expression (activity, pain) and psychosocial factors, including depressed mood and stress contribute to sleep problems in SpA. Future studies, integrating a biopsychosocial approach, are needed to clarify the specific factors and underlying mechanisms that trigger and maintain sleep problems in SpA. The course of sleep problems in SpA remains unknown as studies have been cross sectional. Directions for future research are discussed herein. Routine assessment and management of sleep problems in SpA should be part of the comprehensive care of patients with SpA. While effective pharmacological and nonpharmacological treatments are available to manage sleep problems, few studies have specifically evaluated these strategies for persons living with SpA. Given the complex interplay of factors contributing to sleep problems in SpA, a multimodal treatment approach combining nonpharmacological strategies and medication for more chronic and difficult cases should be utilized for the management of sleep difficulties in SpA.
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    ABSTRACT: Sleep disturbances, including obstructive sleep apnea (OSA), commonly limit function and quality of life in people with spondyloarthritis (SpA). Systemic inflammation has been implicated in the pathophysiology of both OSA and SpA, and suppression of inflammation with tumor necrosis factor α (TNF) inhibitors may decrease OSA severity. In this study, we compared the frequency of OSA in patients receiving and not receiving TNF-inhibitor therapy. Data were collected from 63 consecutively screened veterans with SpA. Participant interviews, examinations, chart reviews, and referrals to the Salt Lake City Veteran Affairs (SLCVA) Sleep Center were used to obtain demographic data, comorbidities, SpA features, therapy data, and sleep study outcomes. OSA occurred in 76% of SpA patients. OSA was less common in patients receiving TNF-inhibitor therapy (57%), compared to patients not receiving TNF-inhibitor therapy (91%) (p = 0.01). OSA is underrecognized in veterans with SpA, and TNF-inhibition was associated with a lower frequency of OSA. CITATION: Walsh JA; Duffin KC; Crim J; Clegg DO. Lower frequency of obstructive sleep apnea in spondyloarthritis patients taking TNF-inhibitors. J Clin Sleep Med 2012;8(6):643-648.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 12/2012; 8(6):643-8. DOI:10.5664/jcsm.2254 · 3.05 Impact Factor
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    ABSTRACT: Sleep disturbance is often reported by the patients with ankylosing spondylitis (AS), with awakenings produced by inflammatory pain. There are limited studies about sleep disturbance on these patients, and especially its association with psychological state and quality of life to examine the prevalence of sleep disturbance and to assess its association with disease-specific variables, psychological status and quality of life. One hundred and ten patients were included in this cross-sectional study according to the modified New York criteria for AS. Clinical and biological parameters were evaluated. Sleep disturbance was assessed by the fourth item of Hamilton Anxiety Scale. Psychological status was assessed by The Hospital Anxiety and Depression Scale including depression subscale and anxiety subscale. The quality of life was evaluated by the short form-36 (SF-36). Sleep disturbance was found in 64.5 %, depression in 55.5 % and anxiety in 60.9 % amongst our patients. Significantly, worse pain, higher disease activity and functional disability were present in patients with sleep disturbance. Likewise, sleep problems were significantly higher in patients with depression, anxiety and in patients with low scores of the SF36. Multivariate logistic regression analysis revealed that the pain (OR = 1.019) and depression (OR = 1.304) were independent risk factors that influenced sleep disturbance. Sleep problems are prevalent amongst Moroccan patients with AS. Our findings suggest that pain and depression were the independent risk factors that influenced the sleep disturbance and hence, the need for evaluation and optimal management of pain and depression to improve sleep quality in AS patients.
    Rheumatology International 03/2012; 33(2). DOI:10.1007/s00296-012-2376-6 · 1.52 Impact Factor
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