Background Sleep disturbance is often seen in patients with systemic lupus erythematosus (SLE). The prevalence of sleep disturbances is high, but the factors contributing to sleep disturbance in SLE patients remain poorly understood. Moreover, correlation between changes in sleep quality and changes in clinical disease activity over time has never been studied.
Objectives This study was performed to determine prevalence of sleep disturbance in SLE, to investigate the factors (e.g. drugs, disease activity, damage score, quality of life, pain, and emotional factors) that might be associated with sleep disturbance, and to observe the correlation between changes in clinical parameters and sleep quality over time.
Methods All SLE patients seen at the rheumatology clinic from June 2009 to 2011were invited to join the study. Demographic data (education, house whole income, marital status) and auto-antibodies (anti-ds DNA, anti Ro and anti La) were recorded at baseline. The participants were assessed 3 times: 1st visit was at baseline, 2nd visit was 1 month later, and 3rd visit was 3 months apart from baseline) using standardized tools, including the Pittsburgh Sleep Quality Index (PSQI), Disease activity (modified SLEDAI-2K), cumulative damage score (SLICC), quality of life (SLEQOL-TH), fatigue symptoms (FACIT), anxiety (HAM-A) and depressed mood (HAM-D), pain severity (VAS). The medications using within 30 days before each visit were recorded.
Results Fifty-six of 497 (11.27%) SLE patients participated in this study. All were females and had their mean (SD) age of 37.49 (12.27) years,and disease duration at study entry of 8.60 (7.28) years. The meanglobal PSQI score at 1st visit was 7.86(4.56), in which 29 of 56 (51.79%) were poor sleepers (PSQI score ≥6). There was no association between sleep quality and demographic data, SLE disease activity, clinical symptoms of SLE, auto-antibodies and medications. In multiple regression analyses, only depression by HAM-D score was the independent determinant of sleep quality, p=0.002.Among the disease-related parameters, quality of life (r =0.33, p=0.013), fatigue symptoms (r =0.40, p=0.002), pain severity (r =0.41, p=0.002), anxiety (r =0.632, p<0.001) and depressed mood (r =0.71, p<0.001) correlated to sleep quality. Fifty-three patients, including 28 poor sleepers, attended the study in every visit. These 28 poor sleepers were treated with pshychotherapy, and 15 of them received sedative drugs. When compared each clinical parameters from 1st visit to 3rd visit, duration of sleep, sleep disturbance, sleep latency, day time dysfunction, sleep quality, anxiety, depressed mood and quality of life were significantly improved overtime. There were significant correlations of changing of PSQI score and changing of HAM-D, HAM-A and SLEQOL-TH overtime in both magnitude and direction.
Conclusions There was a high prevalence of poor sleep quality in Thai SLE patients. Anxiety and depressed mood were strong association to sleep quality in SLE. Awareness of underlying anxiety and depression as well as sleep disturbance in SLE patients, and treat them properly, can help improve in quality of life in these patients.
Disclosure of Interest None Declared
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