Effect of the first infliximab infusion on sleep and alertness in patients with active rheumatoid arthritis
- 1The Sleep Unit of the Respiratory Service, Hospital Clinico Universitario and Medical School, Universidad de Santiago de Compostela, Spain
- 2Rheumatolology Service, Hospital Clinico Universitario and Medical School, Universidad de Santiago de Compostela, Spain
- 3Department of Medicine, Hospital Clinico Universitario and Medical School, Universidad de Santiago de Compostela, Spain
- Correspondence to:
Professor J J Gómez-Reino
Rheumatology Service, Hospital Clínico Universitario, C/Choupana s/n, 15706 Santiago, Spain;
- Accepted 12 May 2003
Objective: To assess the benefit of the first infliximab infusion on sleep disturbances in patients with RA
Material and methods: Evaluation of RA activity, sleepiness (Epworth scale and multiple sleep latency test), alertness (steer clear test), and sleep structure (polysomnography) were conducted before and after the first infusion of infliximab in six female patients with RA.
Results: The day after the first infliximab infusion, the mean (SD) number of tender (20 (2.4)) or swollen (15.3 (2)) joints and the morning stiffness (140 (61.9) min) had not changed. There were significant improvements in the median number of total sleep stage transitions per hour (median (IR) before v after infusion: 20.5 (43) v 7.5 (6); Wilcoxon paired test, p = 0.014), median percentage of phase I+II (83.5 (8) v 54.5 (24); p = 0.023), percentage of REM stages (2 (10) v 11.5 (8); p = 0.014), median percentage sleep efficiency (44 (22) v 75 (18); p = 0.014), median sleep latency (77.5 (150) v 25.5 (23) min; p = 0.023), and median number of hits in the steer clear test (48.5 (86) v 6 (45); p = 0.023). Neither objective nor subjective daytime sleepiness was noted. One obese patient had obstructive sleep apnoea syndrome.
Conclusions: Sleep and the alertness disturbances in RA improve with infliximab treatment. Improvement appears unrelated to joint discomfort amelioration but suggests a central effect through inhibition of circulating TNFα levels.
- EEG, electroencephalography
- OSA, obstructive sleep apnoea
- RA, rheumatoid arthritis
- TNFα, tumour necrosis factor α