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  1. F. Ingegnoli1,
  2. M. Buoli2,
  3. C. Posio3,
  4. R. DI Taranto1,
  5. R. Caporali1
  1. 1Università degli Studi di Milano, Division of Clinical Rheumatology, ASST Pini, Dept. of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Milano, Italy
  2. 2Università degli Studi di Milano, Dept. of Pathophysiology and Transplantation, Dept. of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milano, Italy
  3. 3Università degli Studi di Milano, Dept. of Pathophysiology and Transplantation, Milano, Italy


Background: A decrease in physical activity, exposure to daylight and a decline in psychological wellbeing due to COVID19 pandemic have led to increased incidence of sleep disorders such as difficulties falling asleep, sleep disruption, insomnia, nightmares and daytime sleepiness (1). Patients with inflammatory arthritis are more vulnerable to pain, depression, anxiety and sleep disorders. These complaints are linked in a cyclical pattern that may negatively affect daily-life activities (2-4). To our knowledge, the impact of pandemic on sleep disturbances in patients with inflammatory arthritis has not been evaluated yet.

Objectives: The aim of this study is to establish the COVID-19 related impact on sleep disturbances among patients with inflammatory arthritis who experienced the COVID-19 quarantine in Italy.

Methods: Data about chronic inflammatory arthritis (rheumatoid arthritis [RA], psoriatic arthritis [PsA] and ankylosing spondylitis [AS]) were retrieved from a large nationwide online survey involving patients affected by different rheumatic diseases. From May to September 2020, eleven patients’ associations sent a call to rheumatic patients asking them to complete an anonymous online survey with specific questions also about sleep disturbances and pre- and post-lockdown self-reported use of psychopharmacotherapy. Data were analysed by a binary logistic regression model having the presence of sleep disturbances during COVID 19 pandemic as dependent variable.

Results: 375 of 507 (74%) of patients had inflammatory arthritis: 249 RA, 77 PsA and 49 AS. 291 (77.6%) were females with a median (IQR) age of 54 (44-63) years. There was an increase in the use of psychiatric compounds after quarantine period (59 [15,7%] vs 65 [17,3%]), especially for sleep medications (23 [6,1%] vs 28 [7,5%]) and anxiolytics (15 [4%] vs 18 [4,8%]). 246 (65.6%) of patients had trouble staying asleep, 238 (63.5%) had trouble falling asleep, and 112 (29.9%) had dreams about pandemic (Figure 1 below).

The binary logistic regression suggests that older age (OR= 1.038, p = .040), assumption of medication for psychiatric symptoms before COVID-19 (OR = 25.819, CI 11.465-58.143) and presence of COVID infection (OR = 2.783, CI 1.215-6.372) were predictive of insomnia during pandemic.

Conclusion: These results confirm that sleep disturbances have been a relevant concern in patients with inflammatory arthritis after COVID-19 national lockdown. Changes in daily life related to confinement have influenced psychological distress leading to a significant impact on sleep difficulties such as inability to fall early asleep or to maintain adequate sleep. Furthermore, older patients who had coronavirus infection and were previously treated for psychiatric disorders were at higher risk developing sleep disorders.

References: [1]Voulgaris A, et al. Sleep Med. 2020;73:170-176.

[2]Wolfe F, et al. J Rheumatol. 2006;33:1942-51

[3]Irwin MR, et al. Sleep. 2012;35:537-4

[4]Zielinski MR, et al. Front Immunol. 2019;10:1827.

Acknowledgements: We wish to thank the Lombard Association of Rheumatic Diseases (ALOMAR) for its invaluable contribution to the planning and dissemination the survey, all the Italian associations among which the National Association of People with Rheumatic and Rare Diseases (APMARR) and National Association of People with Rheumatic Diseases (ANMAR) that disseminated the survey through social media. The authors are grateful to all patients for contributing to this project.

Disclosure of Interests: Francesca Ingegnoli: None declared., Massimiliano Buoli: None declared., Cristina Posio: None declared., Raffaele Di Taranto: None declared., Roberto Caporali Speakers bureau: Abbvie, Amgen, BMS, Celltrion, Galapagos, Gilead, Lilly, Pfizer, Roche, UCB, Sanofi, Fresenius Kabi, Samsung bioepis, MSD, Consultant of: Galapagos, Gilead, Lilly,Janssen, MSD.

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