Article

Correlation of Sleep Quality in Spondyloarthritis Patients and its Association with Disease Activitiy Parameters

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Abstract

Background: Patients with chronic medical disorders are substantially more likely to have sleep related issues. Previously, various authors have reported sleep disruptions to be common in rheumatic diseases, although such sleep related issues in the spondyloarthropathies have not received much attention.. Aim: The present study was aimed to assess the effect of spondyloarthropathies on sleep quality and to see whether this effect is associated with disease activity. Material and Methods: This cross-sectional study was conducted in the rheumatology clinic, King Khalid University Hospital, during the duration of two months. A total of 85 diagnosed cases of spondyloarthritis were included. All participants were interviewed regarding their Demographic details, disease duration, medications, treatment regimens and physical examination. Sleep disturbance was measured using Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index, and the Ankylosing Spondylitis Quality of Life scale. The intensity of disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and patient’s functional status was evaluated using the Bath Ankylosing Spondylitis Functional Index (BASFI). Blood inflammatory markers like ESR levels and CRP levels were also calculated for each patient. Results: Among the total 79 cases included, mean age of patients was 41.06±11.78 years, 40 (50.6%) were females, mean disease duration was 5 years. Diagnoses included Ankylosing spondylitis (48.10%), Psoriatic arthritis (43.04%), Undifferentiated spondyloarthopathy (6.33%) and IBD-related arthropathy (2.53%). Spondyloarthritis was observed to be associated with considerable impaired sleep quality on (PSQI) questionnaire. Six out of seven studied components came out to be worse and the only component which remained unaffected was “use of sleep Medication”. A significant correlation was observed between disease severity and patients ESR and CRP levels, and a significant correlation was observed between BASDAI score and all seven sleep quality parameters and overall PSQI scores. Both BASDAI score and BASFI scores correlated significantly with each other and a significant correlation was observed between the functional status (BASFI score) and Six sleep quality parameters except for use of sleep medication. Conclusion: We conclude that the sleep related problems were significantly higher in patients with spondyloarthritis and patients during active phase of disease had decreased sleep quality. Keywords: spondyloarthropathies, sleep quality, disease activity, PSQI scores.

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To determine the association between insomnia and health-related quality of life (HRQOL) in patients with chronic illness after accounting for the effects of depression, anxiety, and medical comorbidities. We used a cross-sectional analysis of Medical Outcomes Study (MOS) data. The sample consisted of 3445 patients who completed a self-administered questionnaire and who were given a diagnosis of 1 or more of 5 chronic medical and psychiatric conditions by an MOS clinician. Patients were recruited from the offices of clinicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry in 3 US cities. Outcomes were sleep items, health-related quality of life as measured by the Medical Outcomes Study Short Form Health Survey (SF-36), chronic medical comorbidity, depression, and anxiety. Insomnia was defined as the complaint of difficulty initiating or maintaining sleep. Insomnia was severe in 16% and mild in 34% of study patients. Patients with insomnia demonstrated significant global decrements in HRQOL. Differences between patients with mild insomnia versus no insomnia showed small to medium decrements across SF-36 subscales ranging from 4.1 to 9.3 points (on a scale of 0 to 100); the corresponding decrements for severe insomnia (versus no insomnia) ranged from 12.0 to 23.9 points. Insomnia is independently associated with worsened HRQOL to almost the same extent as chronic conditions such as congestive heart failure and clinical depression.
Article
Obstructive sleep apnea (OSA) has been increasingly linked to cardiovascular and cerebrovascular disease. Inflammatory processes associated with OSA may contribute to cardiovascular morbidity in these patients. We tested the hypothesis that OSA patients have increased plasma C-reactive protein (CRP). We studied 22 patients (18 males and 4 females) with newly diagnosed OSA, who were free of other diseases, had never been treated for OSA, and were taking no medications. We compared CRP measurements in these patients to measurements obtained in 20 control subjects (15 males and 5 females) who were matched for age and body mass index, and in whom occult OSA was excluded. Plasma CRP levels were significantly higher in patients with OSA than in controls (median [range] 0.33 [0.09 to 2.73] versus 0.09 [0.02 to 0.9] mg/dL, P<0.0003). In multivariate analysis, CRP levels were independently associated with OSA severity (F=6.8, P=0.032). OSA is associated with elevated levels of CRP, a marker of inflammation and of cardiovascular risk. The severity of OSA is proportional to the CRP level.
Article
The aim of this study was to develop a Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and assess its reliability, validity, and sensitivity to change. The Turkish version was obtained after a translation and back-translation process. Seventy-one patients with ankylosing spondylitis were assessed with it. To assess its validity, patients were also evaluated with the Turkish version of the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Bath Ankylosing Spondylitis Patient Global Score (BAS-G), and physicians' assessments of disease activity. Over 24 h, the Turkish BASDAI did not show significant differences between the two assessments (P>0.05). Correlations were found between BASDAI and all of the evaluation parameters except BASMI (P<0.01). Both BASDAI and BASMI showed significant improvements after 8-week home exercise programmes. The results of this study show that the Turkish version of the BASDAI is reliable, valid, and sensitive to change.
Article
Due to its high prevalence, considerable impact on well-being, and high medical and societal costs, insomnia represents an important healthcare challenge. Despite this, the prevalence of this condition is under-recognized and many sufferers do not receive adequate treatment. This international survey investigated the prevalence and characteristics of insomnia in the general population in France. Italy, Japan and the USA to better understand why insomnia is under-recognized and under-treated. Type, frequency, natural history of night- and day-time symptoms, and attitudes of people regarding the nature and treatment of insomnia was quantitatively assessed from a representative sample of the general population aged > 18 years in each of the four countries. A survey of an extensive series of standardized 10-15-min interviews was conducted over the telephone by professional interviewers. Insomnia was reported by 37.2% of respondents in France and Italy, 6.6% in Japan, and 27.1% in the USA. The mean number of symptoms reported per patient was two, with sleep maintenance insomnia the most predominant symptom (73%), followed by difficulty falling asleep (61%), and poor sleep quality (48%). Daytime fatigue and impaired concentration and attention were the most commonly reported next-day symptoms as a result of poor sleep. The majority of individuals with sleep problems reported being 'somewhat' or 'very' bothered by their symptoms, and reported that their sleep problems impacted on their daily quality of life either 'somewhat' or 'a lot'. Among individuals with a history of insomnia, the rate of reporting insomnia symptoms to physicians was generally low and of those who did consult a physician, few were prescribed any medication. The results of this study suggest that in Europe, Japan and the USA, the burden of insomnia on sufferers is considerable. Many respondents took no action to alleviate their insomnia symptoms despite the poor sleep impacting on their daily quality of life either 'somewhat' or 'a lot'.
Article
Ankylosing spondylitis is a common inflammatory rheumatic disease that affects the axial skeleton, causing characteristic inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life. New imaging techniques and therapies have substantially changed the management of this disease in the past decade. Whether inhibition of radiographic progression and structural damage can be reached with available drugs is as yet unclear. Furthermore, treatment with non-steroidal anti-inflammatory agents and physiotherapy remains an important approach to long-term management of patients with ankylosing spondylitis. The new treatment options with tumour necrosis factor blockers seems a breakthrough for patients refractory to conventional treatment.
Article
To investigate whether sleep disturbances are associated with C-reactive protein (CRP) levels at the population level. Elevated CRP levels have been found to accompany sleep disturbances, but evidence so far comes only from limited clinical and experimental studies; epidemiological studies are lacking. We utilized the Northern Finland 1966 Birth Cohort, whose participants have been followed up to the age of 31 years. The hs-enzyme immunoassay method was used to measure highly sensitive-CRP (hs-CRP) concentrations (4011 participants). Self-reported sleep disturbances were ranked from 1 (no problem) to 5 (severe disturbances). Multivariate analyses, after adjusting for confounders, revealed that hs-CRP levels in men in the sleep disturbance category "moderate, considerable and severe" (i.e., self-reported sleep disturbances rated 3, 4, or 5), were >18% (18.2%, 95% Confidence Interval 3.0% to 36.3%) higher than those in men with "no" sleep disturbance. In women, hs-CRP levels did not significantly differ between different sleep disturbance categories. Our results support the hypothesis that moderate-to-severe sleep disturbances in men are associated with slightly increased CRP levels at the epidemiological level. Further investigations are called for to see whether our results can be replicated in other databases.
Article
Arthritis is the leading cause of chronic illness in the United States. Seventy-two percent of the adults aged 55 years and older with arthritis report sleep difficulties. This review discusses sleep disorders associated with rheumatoid arthritis, juvenile rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, scleroderma, Behcet's disease, seronegative spondyloarthropathies, osteoarthritis, sarcoidosis, and fibromyalgia. We describe the inter-relationship between sleep complaints, disease activity, depression, sleep deprivation, and cytokines. An algorithm for evaluation and treatment of sleep disorders associated with rheumatologic diseases is proposed.
Determinants of sleep quality in women with systemic lupus erythematosus
  • Da Costa
  • D Bernatsky
  • S Dritsa
  • M Clark
  • A E Dasgupta
  • K Keshani
  • A Pineau
Da Costa D, Bernatsky S, Dritsa M, Clark AE, Dasgupta K, Keshani A, Pineau C (2005). Determinants of sleep quality in women with systemic lupus erythematosus. Arthritis Care and Research 53: 272-8
Reliability and validity of the Pittsburgh sleep quality index
  • Xianchen Liu
  • Maoqin Tang
  • Lei Hu
  • Aizhen Wang
  • Hongxin Wu
  • Guifang Zhao
  • Chunni Gao
  • Wanshun Li
Xianchen Liu, Maoqin Tang, Lei Hu, Aizhen Wang, Hongxin Wu, Guifang Zhao, Chunni Gao, Wanshun Li. Reliability and validity of the Pittsburgh sleep quality index. Clin J Psychiatry. 1996;29:103-107. 15. Available at: https://www.ons.org/sites/default/files/InsomniaSeverityIndex _ISI.pdf 16.
Sleep quality in patients with ankylosing spondylitis. Revista brasileira de reumatologia
  • E Aydin
  • K Bayraktar
  • Y Turan
  • I Omurlu
  • E Tastaban
  • O F Sendur
Aydin E, Bayraktar K, Turan Y, Omurlu I, Tastaban E, Sendur OF. Sleep quality in patients with ankylosing spondylitis. Revista brasileira de reumatologia. 2015 Jul;55:340-5.