Background Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting primarily the axial skeleton. Inflammatory back pain, spinal stiffness and limited spinal mobility are the characteristics AS, and can lead to structural and functional impairments and a decrease in quality of life. Sleep disturbances have been reported to be more frequent in AS than in the normal population and other rheumatic diseases. Sleep disturbances are greatly associated with the inflammatory back pain, stiffness, disease activity, depression, quality of life and the limitation of mobility in patients with AS. Sleeping positions can affect and/or can reflect sleeping disturbances.
Objectives The aim of the study was to evaluate sleeping positions and sleep disturbances in patients with AS.
Methods Seventy-seven patients with AS and 46 healthy volunteers (healthy control [HC] group) were enrolled in the study. Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life Scale (ASQOL) and visual analogue scale (VAS) were applied in the AS group. The Hospital Anxiety and Depression Scale (HADS) including depression subscale (HADS-D) and anxiety subscale (HADS-A), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were applied in the both groups. Most common sleeping postures (foetus, yearner, log, soldier, free-fall and star-fish) were noted.
Results There was no significant difference between the AS and HC groups in terms of sleeping positions (p=0.347, Table). In the AS group, disease durations, acute phase reactants levels, BASDAI, BASFI, BASMI, HAQ, PSQI, ISI, HADS-A, and HADS-D scores were similar among the patients preferred different positions (p>0.05 for all). On the other hand, the ASOqL, VAS, and patient global assessment scores were higher in the AS patients preferred foetus position than in yearner position (p=0.008, p=0.001, and p=0.01, respectively). The selections of positions of active and inactive patients were also similar (p>0.05). In the AS group, total PSQI (8.03±4.64 vs. 5.86±2.54, p=0.004) and ISI (9.71±7.40 vs. 7.14±6.14, p=0.038) scores were higher than in the HC group. Moreover, active patients had total PSQI (10.07±4.41 vs. 4.68±2.66, p<0.001) and ISI (12.17±7.28 vs. 5.00±4.96, p<0.001) compared to the inactive ones.
Conclusions Sleeping disturbance is a trouble in patients with AS compared to the healthy ones and in active AS patients compared to the inactive ones. However, sleeping positions seem not to affect neither sleeping disturbance nor disease activity, in AS.
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Disclosure of Interest None declared
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