Background Sleep disturbances are frequently found in patients affected by rheumatic conditions (1). Chronic pain, the most common manifestation of these conditions is associated to poor sleep (2).
Objectives Our primary objective was to evaluate prevalence of excess daytime sleepiness and impaired sleep quality in a patient population at the first access to a Rheumatology outpatient clinic. Secondary objective was evaluation of pain and others factors well known to be associated to sleep disorders.
Methods 961 out of 1454 (mean age was 52.6 years; 14.3% were male) consecutive patients admitted for the first time to an Italian Rheumatology Outpatient Clinic, between December 2014 and November 2016, accepted to answer a self-administered questionnaire study. We considered the following parameters: pain intensity on visual analogic scale ranging from 0 to 100 according to commonly used classification (3), patient's assessment of General Health (GH), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Health Assessment Questionnaire (HAQ), and Body Mass Index (BMI). Smoke habits were also considered.
Results 70 patients showed both sleep disorders (7.3%),624 patients had only impaired sleep quality (64.9%), 25 showed isolated excessive daytime sleepiness (2.6%). 242 patients did not have any sleep disorders (25.2%). We found that the presence of both ESS≥10 and PSQI≥5 was correlated to moderate-severe pain VAS pain≥40, BMI≥35, HAQ≥1 and GH≥50 with a statistical significance (respectively p=0.004; p=0.032; p=0.0004; p=0.0001). A correlation with GH≥50 in the patient group with only PSQI≥5 was detected (p=0.03). Smoke habits did not correlate with sleep disturbance measures investigated. No other correlations were found in the other groups.
Conclusions Thus excess daytime sleepiness and impaired sleep quality may be a target of therapeutic intervention in the treatment of rheumatic conditions. Further studies are needed to generalize results and suggestions.
Generaal E, Vogelzangs N, Penninx WJH, Dekker J. Insomnia, sleep duration, depressive symptoms, and the onset of chronic multisite musculoskeletal pain. Sleep 2017; 40.
Vivien C Abad, Priscilla S.A. Sarinas, Christian Guilleminault. Sleep and rheumatologic disorders. Sleep Medicine Reviews 2008; 12: 211–228.
Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of post-operative pain. J Pain 2003;4:407–14.
Disclosure of Interest None declared