Background Sleep disturbance is common in rheumatoid arthritis (RA). Sleep disturbance is thought to have some influence on psychological state, self-efficacy and Quality of Life (QOL) in patients with RA.
Objectives To evaluate the correlation of sleep disturbance with disease activity, psychological state, self-efficacy and QOL in patients with RA.
Methods All participants with RA recruited met the RA diagnosis according to the 2010 EULAR criteria and informed consent was obtained. These patients were divided to insomnia group (PSQI ≥5.5) and non-insomnia group (PSQI<5.5) according to the sleep disturbance with Pittsburgh Sleep Quality Index (PSQI). Disease activity was assessed with swollen joint counts (SJC), tender joint counts (TJC), evaluator global assessment (EGA), patient global assessment (PGA) and clinical disease activity index (CDAI). Anxiety was assessed utilizing the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), while depression was evaluated with the Center for Epidemiological Studies Depression (CES-D) and HADS-Depression (HADS-D). Self-efficacy and QOL were evaluated with General Self-Efficacy Scale (GSES) and Sort Form-36 (SF-36), respectively. These data were compared between insomnia group and non-insomnia group. These data were analyzed utilizing Fischer's exact test and Wilcoxon rank sum test.
Results One hundred twelve patients (18 males and 94 female) were assessed in this study. The number of patients with sleep disturbance examined with PSQI was 44 among 112 patients (39.3%). There was no significant difference in age, disease duration and dose of prednisolone between insomnia group (n=44) and non-insomnia group (n=68) (p=0.0771, p=0.6693, p=0.7524, respectively). There was also no significant difference in SJC, TJC, EGA and CDAI between two groups (p=0.1415, p=0.7033, p=0.1358, p=0.5345, respectively). However, PGA was significantly lower in non-insomnia group (p<0.005). Similarly, STAI (state) was significant lower in non-insomnia group compared with insomnia group (p<0.0005), while there was no significant difference in STAI (trait) (p=0.5708). GSES was significantly higher in non-insomnia group (p=0.0197). The ratio of the patients with anxiety evaluated by HADS-A was higher in insomnia group compared with non-insomnia group (p<0.01). Similarly, the ratio of the patients with depression evaluated by HADS-D and CES-D were higher in insomnia group (p<0.005, p<0.0001, respectively). In SF-36, there was no significant difference in physical component summary (PCS) between 2 groups (p=0.7817), while mental component summary (MCS) is significantly better in non-insomnia group (p<0.0001).
Conclusions It is suggested that there is a correlation between sleep disturbance and PGA, anxiety and depression, self-efficacy and QOL in patients with RA. This study provides that treatment for sleep disturbance may be effective for improvement of PGA, psychological state, self-efficacy and QOL in patients with RA.
Disclosure of Interest None declared
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