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Katz P, Pedro S, Michaud K. Sleep Disorders Among Individuals With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:1250-1260. [PMID: 35997482 DOI: 10.1002/acr.24999] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Self-reported sleep problems are common in rheumatoid arthritis (RA), with potential negative health implications, yet relatively little research has focused on sleep in RA. We examined the prevalence of obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS) symptoms, and short sleep (SS) in a large RA cohort (n = 4,200) and factors associated with each. METHODS Data are from FORWARD, The National Databank for Rheumatic Diseases. Validated screening measures assessed OSA risk and RLS symptoms. SS was based on self-reported average sleep time (<6 hours). The Medical Outcomes Study Sleep Problems Index I measured self-reported sleep quality. Multivariable logistic regression models identified independent predictors of sleep disorders and sleep quality and the independent association of OSA risk, RLS symptoms, and SS with self-reported poor sleep quality. RESULTS Twenty-one percent (n = 899) had OSA diagnosis or risk, 30% (n = 1,272) had RLS symptoms or diagnosis, and 43% (n = 1,737) reported SS, and RA disease activity was associated with each sleep disorder. Abatacept use was associated with lower odds of RLS and SS. Use of conventional disease-modifying antirheumatic drugs or abatacept was less frequent in the SS group. No medications were associated with OSA in multivariable analyses. Both RLS and SS was associated with worse perceived sleep quality. DISCUSSION Almost two-thirds met criteria for at least one sleep disorder. RA disease activity and pain were significantly associated with each sleep condition. Additional research is needed to identify the causal pathway between sleep disorders and RA disease activity and pain and the long-term consequences of sleep disorders in RA.
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Affiliation(s)
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha
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2
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Chu P, Ju YES, Hinze AM, Kim AH. Measures of Sleep in Rheumatologic Diseases: Sleep Quality Patient-Reported Outcomes in Rheumatologic Diseases. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:410-430. [PMID: 33091275 PMCID: PMC7586459 DOI: 10.1002/acr.24238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Philip Chu
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Yo-El S. Ju
- Sleep Medicine Center, Department of Neurology, Washington University School of Medicine, Saint Louis, MO
| | - Alicia M. Hinze
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Alfred H.J. Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
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3
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Wali S, Mustafa M, Manzar D, Bawazir Y, Attar S, Fathaldin O, Bahlas S, Alsolaimani R, Alhejaili F, Abdelaziz M. Prevalence of obstructive sleep apnea in patients with rheumatoid arthritis. J Clin Sleep Med 2020; 16:259-265. [PMID: 31992430 DOI: 10.5664/jcsm.8178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although previous studies suggested an increased prevalence of obstructive sleep apnea (OSA) among patients with rheumatoid arthritis (RA), no existing large prospective study has addressed this association using objective measures. This study aims to assess the prevalence of OSA using polysomnography (PSG) in patients with RA and its relationship with RA activity. METHODS Patients with RA who presented at the rheumatology clinic at a university hospital from 2017 to 2018 were eligible. In the first stage, data from the Disease Activity Score 28, Berlin questionnaire, and Epworth Sleepiness Scale were obtained, along with personal data and a comprehensive medical history. The second stage involved a case-control study confirming OSA with PSG. OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/h, whereas patients with an AHI ≥ 15 events/h were categorized as having moderate-severe OSA. RESULTS In total, 199 patients with RA were recruited, 110 patients (55%) underwent PSG, and 5 were excluded. The mean age was 48.93 ± 12.7 years, and the mean body mass index was 31.70 ± 9.74 kg/m²; 94% were female. In total, 67 participants (33.2%) were at high risk for OSA (36 [55.4%] underwent PSG), whereas 132 (66.8%) were at low risk (69 [51.5%] underwent PSG). The estimated prevalence of OSA (AHI ≥ 5 events/h) in the whole population was 58.1%, whereas the prevalence of moderate-to-severe OSA (AHI ≥ 15) was 22.9%. CONCLUSIONS This prospective PSG-based study demonstrated that OSA is more common in patients with RA than in the general population, but there appears to be no relationship with disease activity.
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Affiliation(s)
- Siraj Wali
- Sleep Medicine Research Group, Sleep Medicine and Research Center, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohammad Mustafa
- Department of Medicine, Rheumatology Unit, University of Jeddah, Jeddah, Saudi Arabia
| | - Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Yasser Bawazir
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Suzan Attar
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Fathaldin
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sami Bahlas
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Roaa Alsolaimani
- Department of Medicine, Rheumatology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faris Alhejaili
- Sleep Medicine Research Group, Sleep Medicine and Research Center, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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4
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Kontodimopoulos N, Stamatopoulou E, Kletsas G, Kandili A. Disease activity and sleep quality in rheumatoid arthritis: a deeper look into the relationship. Expert Rev Pharmacoecon Outcomes Res 2019; 20:595-602. [PMID: 31587587 DOI: 10.1080/14737167.2020.1677156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: This study looks deeper into the relationship between rheumatoid arthritis (RA) disease activity and distinct dimensions of sleep quality. Methods: The Pittsburgh Sleep Quality Index (PSQI) was administered to a cohort of 147 RA patients. Health-related quality of life (HRQoL) and fatigue were measured with the SF-12 and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) instruments, respectively, whereas RA activity was determined with the Disease Activity Score 28 joints (DAS28). Ethical approval for the study and informed consent from the participants were obtained. Results: Most patients were females (78.2%), and the mean age of the entire sample was 63.7 years. Most participants (77.6%) were poor sleepers (i.e. PSQI ≥ 5) who suffered from fatigue more than good sleepers (FACIT-F: 21.6 vs. 39.3, p < 0.001). Overall sleep quality correlated, in the expected directions, with disease activity (Spearman's rho = 0.87, p < 0.001), physical health (-0.66, p < 0.001), mental health (-0.71, p < 0.001), and fatigue (0.87, p < 0.001). PSQI and its component scores differed across patient subgroups with increasing RA activity, even after adjusting for confounding variables. Conclusion: RA disease activity distinctly affects sleep quality, and given the already demonstrated importance of good sleep, this 'deeper look' might contribute to the effort to improve HRQoL in RA patients.
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Affiliation(s)
- Nick Kontodimopoulos
- Faculty of Social Sciences, Hellenic Open University , Patras, Greece.,Division of Management, "KAT" General Hospital , Athens, Greece
| | | | - Georgios Kletsas
- Faculty of Social Sciences, Hellenic Open University , Patras, Greece
| | - Anna Kandili
- Rheumatology Outpatient Clinic, Iaso General Hospital , Athens, Greece
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5
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Daïen CI, Tubery A, Beurai-Weber M, du Cailar G, Picot MC, Jaussent A, Roubille F, Cohen JD, Morel J, Bousquet J, Fesler P, Combe B. Relevance and feasibility of a systematic screening of multimorbidities in patients with chronic inflammatory rheumatic diseases. Joint Bone Spine 2019; 86:49-54. [DOI: 10.1016/j.jbspin.2018.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/15/2018] [Indexed: 12/14/2022]
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6
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Shaver JL, Iacovides S. Sleep in Women with Chronic Pain and Autoimmune Conditions: A Narrative Review. Sleep Med Clin 2018; 13:375-394. [PMID: 30098754 DOI: 10.1016/j.jsmc.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic pain and sleep disturbances are intricately intertwined. This narrative review provides comments on observations related to pain, stress-immunity, and sleep. Sleep evidence is reviewed from studies of select conditions involving pain (ie, functional somatic syndromes and autoimmune) that are predominant in women. Chronic pain and poor sleep encompass persistent stress-immune activation with systemic inflammation, cellular oxidative stress, and sick behavior indicators that increase morbidity and threaten quality of life. In painful conditions, sleep impairments are nearly ubiquitous, and exaggerated combined effects should not be underestimated or ignored, nor should crucial implications for clinical practice and research.
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Affiliation(s)
- Joan L Shaver
- Biobehavioral Health Science Division, University of Arizona College of Nursing, 1305 North Martin Avenue, Tucson, AZ 85721, USA.
| | - Stella Iacovides
- Faculty of Health Sciences, Brain Function Research Group, School of Physiology, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
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7
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Sleep impairment: an obstacle to achieve optimal quality of life in rheumatoid arthritis. Rheumatol Int 2018; 38:2183-2192. [DOI: 10.1007/s00296-018-4155-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/06/2018] [Indexed: 01/08/2023]
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8
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Purabdollah M, Lakdizaji S, Rahmani A. Relationship between Sleep, Pain and Inflammatory Markers in Patients with Rheumatoid Arthritis. J Caring Sci 2017; 6:249-255. [PMID: 28971075 PMCID: PMC5618949 DOI: 10.15171/jcs.2017.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/10/2017] [Indexed: 12/22/2022] Open
Abstract
Introduction: Rheumatoid Arthritis (RA) is known as a
progressive chronic auto-immune disease. Measurement of inflammatory markers are applied
for follow up the activity of disease. So determining factors that effects these markers
such as sleep and pain can help to prevent the severity of disease. The aim of study was
to determine the relationship between sleep disorders, pain and inflammatory markers in
patients with RA. Methods: Participants included 210 patients with RA referred
to educational medical clinics of Imam Reza and Sina in Tabriz selected by convenience
sampling. They were assessed by Sleep Disorders Questionnaire (SDQ) and Epworth Sleepiness
Scale (ESS). Visual Analog Scale (VAS) also applied for pain measurement. Data were
analyzed using SPSS ver.13 by descriptive and inferential statistics. Results: Most of participants (74%) were female, the mean
age of participants was 48.41 years. The mean (SD) of sleepiness was 13.14 (5.6) and pain
6.09 (2.14). Significant relationship obtained between sleep disorders and pain. As well
as sleep problems had significant relation with CRP. Also pain had significant correlation
with inflammatory markers. Conclusion: Sleep pattern in RA appears to be disrupted by
pain. Pain severity and sleep problems can predict increasing inflammatory markers that
can be a clues of intensity of disease. So relieving pain and improved sleep can decrease
the intensity of disease.
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Affiliation(s)
- Majid Purabdollah
- Medical Surgical Nursing Department, Nursing and Midwifery Faculty, Tabriz University of Medical Science, Tabriz, Iran
| | - Sima Lakdizaji
- Medical Surgical Nursing Department, Nursing and Midwifery Faculty, Tabriz University of Medical Science, Tabriz, Iran
| | - Azad Rahmani
- Medical Surgical Nursing Department, Nursing and Midwifery Faculty, Tabriz University of Medical Science, Tabriz, Iran
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9
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Validity of the Berlin questionnaire in detecting obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2017; 36:116-124. [PMID: 28599983 DOI: 10.1016/j.smrv.2017.04.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 01/06/2023]
Abstract
We aimed to systematically review the Berlin questionnaire as a screening tool for obstructive sleep apnea. We systematically searched PubMed, Embase, and Scopus databases, reviewed articles reporting the Berlin questionnaire's diagnostic utility as measured against type-1 polysomnography, and performed meta-analyses where possible. Thirty five eligible articles showed that the Berlin questionnaire's diagnostic utility varied by study population, definition of hypopnea used, and apnea-hypopnea index threshold used. It had good sensitivity and specificity for detecting clinically relevant obstructive sleep apnea as well as any obstructive sleep apnea in the sleep clinic population. Despite limited evidence, it showed modest to high sensitivity for detecting clinically relevant obstructive sleep apnea or any obstructive sleep apnea in other clinical and general population subgroups. Its specificity was relatively low. Possible reasons for variability in reported diagnostic utility of the Berlin questionnaire are multifaceted. We conclude that the Berlin questionnaire is useful as a clinical screening test and epidemiological tool in the sleep clinic population. Despite limited evidence, it likely has potential clinical and research utility in other populations. Adopting more consistent methodological definitions and focussing more on the general population and specific clinical populations to determine its usefulness as a clinical or epidemiological screening tool are recommended.
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10
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Shen TC, Hang LW, Liang SJ, Huang CC, Lin CL, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC. Risk of obstructive sleep apnoea in patients with rheumatoid arthritis: a nationwide population-based retrospective cohort study. BMJ Open 2016; 6:e013151. [PMID: 27895064 PMCID: PMC5168499 DOI: 10.1136/bmjopen-2016-013151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Sleep disorders are prevalent medical disorders in patients with rheumatoid arthritis (RA). However, whether patients with RA are at an increased risk of developing obstructive sleep apnoea (OSA) is unclear. DESIGN Using population-based retrospective cohort study to examine the risk of OSA in patients with RA. SETTING We used claims data of the National Health Insurance Research Database (NHIRD) of Taiwan. PARTICIPANTS We identified a RA cohort with 33 418 patients newly diagnosed in 2000-2010 and a randomly selected non-RA comparison cohort with 33 418 individuals frequency matched by sex, age and diagnosis year. PRIMARY AND SECONDARY OUTCOME MEASURES Incident OSA was estimated by the end of 2011. The HRs of OSA were calculated using the Cox proportional hazards regression analysis. RESULTS The overall incidence rate of OSA was 75% greater in the RA cohort than in the non-RA cohort (3.04 vs 1.73/10 000 person-years, p<0.001), with an adjusted HR (aHR) of 1.75 (95% CI 1.18 to 2.60). Stratified analyses by sex, age group and comorbidity revealed that the incidence rates of OSA associated with RA were higher in all subgroups. CONCLUSIONS This population-based retrospective cohort study suggested that patients with RA should be monitored for the risk of developing OSA.
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Affiliation(s)
- Te-Chun Shen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
- Intensive Care Unit, Chu Shang Show Chwan Hospital, Nantau, Taiwan
| | - Liang-Wen Hang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
- Sleep Medical Center, China Medical University Hospital, Taichung, Taiwan
| | - Shinn-Jye Liang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
- Sleep Medical Center, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Chung Huang
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Immunology and Rheumatology, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yen Tu
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Hsia
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chuen-Ming Shih
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- College of Public Health, Kunming Medical University, Kunming, YuanNan, China
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11
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Jullian-Desayes I, Revol B, Chareyre E, Camus P, Villier C, Borel JC, Pepin JL, Joyeux-Faure M. Impact of concomitant medications on obstructive sleep apnoea. Br J Clin Pharmacol 2016; 83:688-708. [PMID: 27735059 DOI: 10.1111/bcp.13153] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 01/11/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is characterized by repeated episodes of apnoea and hypopnoea during sleep. Little is known about the potential impact of therapy drugs on the underlying respiratory disorder. Any influence should be taken into account and appropriate action taken, including drug withdrawal if necessary. Here, we review drugs in terms of their possible impact on OSA; drugs which (1) may worsen OSA; (2) are unlikely to have an impact on OSA; (3) those for which data are scarce or contradictory; and (4) drugs with a potentially improving effect. The level of evidence is ranked according to three grades: A - randomized controlled trials (RCTs) with high statistical power; B - RCTs with lower power, non-randomized comparative studies and observational studies; C - retrospective studies and case reports. Our review enabled us to propose clinical recommendations. Briefly, agents worsening OSA or inducing weight gain, that must be avoided, are clearly identified. Drugs such as 'Z drugs' and sodium oxybate should be used with caution as the literature contains conflicting results. Finally, larger trials are needed to clarify the potential positive impact of certain drugs on OSA. In the meantime, some, such as diuretics or other antihypertensive medications, are helpful in reducing OSA-associated cardiovascular morbidity.
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Affiliation(s)
- Ingrid Jullian-Desayes
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Bruno Revol
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France.,Pharmacovigilance Department, Grenoble Alps University Hospital, Grenoble, France
| | - Elisa Chareyre
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Philippe Camus
- Pneumology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Céline Villier
- Pharmacovigilance Department, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Louis Pepin
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Marie Joyeux-Faure
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
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12
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Karatas G, Bal A, Yuceege M, Yalcin E, Firat H, Dulgeroglu D, Karataş F, Sahin S, Cakci A, Ardic S. The evaluation of sleep quality and response to anti-tumor necrosis factor α therapy in rheumatoid arthritis patients. Clin Rheumatol 2016; 36:45-50. [PMID: 27567629 DOI: 10.1007/s10067-016-3387-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/29/2016] [Accepted: 08/16/2016] [Indexed: 12/19/2022]
Abstract
Poor sleep quality (SQ) is increasingly recognized as giving rise to decreased quality of life, and raising pain perception. Our aim is to evaluate the SQ in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor alpha (anti-TNF-α) therapy. This was a prospective observational and open-label study of RA patients. A total of 35 patients with RA were enrolled in this study. Of the 35 patients, 22 had high disease activity (DA), and 13 were in remission. High DA group was initiated an anti TNF-α therapy. Clinical and objective parameters of SQ were assessed by using the Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG). The total PSQI score and the frequency of poor SQ were high in 60 % of the RA patients. The median PSQI score was significantly higher in the high DA group than in the remission group (P = 0.026). Following an anti-TNF-α therapy initiation, significant improvements were observed in the high DA group by PSQI test (P = 0.012). However, no statistically significant difference was found by PSG (P > 0.05). Although an improvement in DA with anti-TNF-alpha therapy did not provide an amelioration in laboratory parameters, we found a significant improvement in SQ by subjective PSQI test. These findings may support that sleep disorders in RA are likely to be associated with a complex pathophysiology.
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Affiliation(s)
- Gulsah Karatas
- Department of Physical Medicine, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, 06100, Altindag, Ankara, Turkey.
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Melike Yuceege
- Department of Respiratory and Sleep Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Elif Yalcin
- Department of Physical Medicine, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, 06100, Altindag, Ankara, Turkey
| | - Hikmet Firat
- Department of Respiratory and Sleep Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Deniz Dulgeroglu
- Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Fatih Karataş
- Department of Internal Medicine and Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Suleyman Sahin
- Department of Internal Medicine and Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Aytul Cakci
- Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sadik Ardic
- Department of Respiratory and Sleep Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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13
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Prevalence of clinically probable obstructive sleep apnea in American veterans with chronic musculoskeletal pain. ACTA ACUST UNITED AC 2016. [DOI: 10.1097/01.hxr.0000511865.62678.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Purabdollah M, Lakdizaji S, Rahmani A, Hajalilu M, Ansarin K. Relationship between Sleep Disorders, Pain and Quality of Life in Patients with Rheumatoid Arthritis. J Caring Sci 2015; 4:233-41. [PMID: 26464840 DOI: 10.15171/jcs.2015.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/27/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis as one of the most common autoimmune diseases is known to be one of the leading causes of disability. Sleep disorders have direct influence on patient's life. According to studies, sleep problems are known to have negative impact on well-being and functioning, but the exact nature of relationship between sleep disorders and Rheumatoid arthritis is not completely understood. This study aimed to investigate the relationship between sleep disorders, pain and quality of life in patients with rheumatoid arthritis patients. METHODS In a descriptive -correlative study, 210 patients with rheumatoid arthritis referred to Tabriz medical university clinics selected by convenience sampling and were assessed by Sleep Disorders Questionnaire (SDQ), Epworth Sleepiness Scale (ESS), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS). Data were analyzed using SPSS-13 by descriptive statistics such as frequency, mean (SD) and inferential statistics including Spearman correlation analysis, linear regression, χ(2),t-test and ANOVA. RESULTS The mean age of participants was 48.41(12.92) years in which most of them (74%) were female. The mean (SD) quality of life was 40.51(22.94), sleepiness 13.14 (5.6) and pain 6.09 (2.14). There was significant negative relationship between some sleep disorders such as (naps, apnea, asphyxia,…) and pain with quality of life but pain severity had more effect on QOL compared to sleep problems. Furthermore, participants had low quality of life with more restriction in physical (mean=34.71) and general health (mean=34.42). CONCLUSION Sleep problems and pain were associated with poor quality of life in Rheumatoid Arthritis patients.
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Affiliation(s)
- Majid Purabdollah
- Department of Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sima Lakdizaji
- Department of Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Department of Nursing, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Iran
| | - Mehrzad Hajalilu
- Department of Internal Medicine, Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khalil Ansarin
- Department of Internal Medicine, Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Taylor-Gjevre RM, Gjevre JA, Nair BV. Increased nocturnal periodic limb movements in rheumatoid arthritis patients meeting questionnaire diagnostic criteria for restless legs syndrome. BMC Musculoskelet Disord 2014; 15:378. [PMID: 25406507 PMCID: PMC4247724 DOI: 10.1186/1471-2474-15-378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/11/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Based on questionnaire criteria, the sensorimotor disorder restless legs syndrome (RLS) has been reported to have a higher prevalence in rheumatoid arthritis (RA) patients than in the general population. There has been some speculation that peripheral arthritic symptoms may allow false positive responses to questionnaire criteria. This study evaluates whether RA patients meeting RLS questionnaire criteria also have objective evidence of increased periodic limb movements (PLMs) characteristic of RLS. METHODS Participants were recruited from RA clinic. Questionnaire data collected at study entry included: pain scores, rheumatoid arthritis disease activity index, Epworth sleepiness scale, Pittsburgh sleep quality index and RLS diagnostic criteria. Each participant was provided a PAM-RL actigraphic monitor, which attached to the ankle. This device was worn for two consecutive nights then returned for data download. Laboratory data including hemoglobin, iron studies, renal function and C-reactive protein levels were collected. RESULTS Of the 57 participants, 23 met RLS diagnostic criteria. Those who met RLS criteria demonstrated higher mean frequency of nocturnal PLMs (19.63/hour; SD:21.13) than those who did not meet RLS criteria (11.13/hour; SD:12.10; p=0.033). There were no significant differences between groups in terms of patient characteristics, disease activity or duration measures. Patients meeting RLS criteria did have poorer sleep quality measures (p <0.001). CONCLUSIONS RA patients who met RLS diagnostic criteria demonstrated higher frequencies of nocturnal PLMs than RA patients who did not meet criteria for RLS. This finding supports use of the RLS diagnostic criteria in helping to differentiate between RA arthritic symptoms and RLS.
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Affiliation(s)
- Regina M Taylor-Gjevre
- Division of Rheumatology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8.
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Obstructive sleep apnea in patients with rheumatoid arthritis: Correlation with disease activity and pulmonary function tests. EGYPTIAN RHEUMATOLOGIST 2014. [DOI: 10.1016/j.ejr.2014.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Clarke LL, Wilson S, Kirwan JR. Using actigraphy to measure sleep patterns in rheumatoid arthritis: a pilot study in patients taking night-time prednisone. Musculoskeletal Care 2013; 11:179-185. [PMID: 23695990 PMCID: PMC3787780 DOI: 10.1002/msc.1052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 09/02/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Poor sleep quality is a commonly reported but under-investigated consequence of rheumatoid arthritis (RA). Actigraphy is a non-invasive way of measuring sleep, estimated from the frequency and intensity of physical movement at the wrist. We used actigraphy to measure sleep parameters compared with sleep questionnaire data, and assessed the practicality of actigraph use in patients with RA. METHODS In a pilot study of actigraphy conducted within an investigation of night-time prednisone treatment and circadian interleukin-6 concentrations in ten patients with active RA, we compared actigraphy with the St Mary's Hospital Sleep Questionnaire and assessed whether night-time administration of prednisone resulted in increased sleep disturbance. RESULTS The actigraph watch was well tolerated by our patients, producing adequate data for analysis for 128 out of 133 test days (96.2%). The results indicated reasonable concordance between actigraph and sleep questionnaire data in the present sample. Patient satisfaction with sleep (question 11) strongly correlated with sleep efficiency measured by the actigraph (r = 0.71, p = 0.22) and showed a trend for inverse correlation with the fragmentation index (r = -0.60, p = 0.067). Quality of sleep (question 9) correlated non-significantly with the fragmentation index (r = -0.59, p = 0.072). We were unable to identify any significant correlations between clinical measures of disease and sleep parameters in this sample. There were no apparent detrimental consequences of the night-time dose of prednisone on the measures of sleep quality and quantity. CONCLUSION In spite of the physical disability imposed by RA, the actigraph was well tolerated and gave a useful measure of sleep in patients with active disease. It has the potential for use in larger controlled trials.
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Affiliation(s)
- Lynsey L Clarke
- University of Bristol Academic Rheumatology Unit, Bristol Royal InfirmaryBristol, UK
| | - Sue Wilson
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of BristolBristol, UK
| | - John R Kirwan
- University of Bristol Academic Rheumatology Unit, Bristol Royal InfirmaryBristol, UK
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Mondal P, Gjevre JA, Taylor-Gjevre RM, Lim HJ. Relationship between the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in a sleep laboratory referral population. Nat Sci Sleep 2013; 5:15-21. [PMID: 23620689 PMCID: PMC3630984 DOI: 10.2147/nss.s40608] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sleep health questionnaires are often employed as a first assessment step for sleep pathology. The Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) are two commonly employed questionnaire instruments. Aspects of sleep health may be measured differently depending on choice of instrument. OBJECTIVES In a patient population at high risk for sleep disorders, referred for polysomnography (PSG), we evaluated the level of association between results from these two instruments. Questionnaire results were also compared with measured PSG parameters. METHODS Records of patients undergoing overnight PSG in the sleep laboratory between February-June 2011 were retrospectively reviewed for eligibility. Inclusion criteria were met by 236 patients. PSQI and ESS scores, demographic information, and PSG data were extracted from each record for analysis. Four subgroups based on normal/abnormal values for ESS and PSQI were evaluated for between-group differences. RESULTS Of 236 adult participants, 72.5% were male, the mean age was 52.9 years (13.9), mean body mass index (BMI) 34.4 kg/m(2) (8.3), mean ESS 9.0 (4.8; range: 0-22), PSQI mean 8.6 (4.2; range: 2-19). The Pearson correlation coefficient was r = 0.13 (P = 0.05) for association between ESS and PSQI. Participants with an abnormal ESS were more likely to have an abnormal PSQI score (odds ratio 1.9 [1.1-3.6]; P = 0.03). Those with an abnormal ESS had higher BMI (P = 0.008) and higher apnea-hypopnea indexes (AHI) (P = 0.05). Differences between the four subgroups were observed for BMI and sex proportions, but not for AHI. CONCLUSIONS We observed limited association between these two commonly used questionnaire instruments, the ESS and the PSQI. These two questionnaires appear to evaluate different aspects of sleep. In terms of clinical application, for global assessment of patients with sleep problems, care should be taken to include instruments measuring different facets of sleep health.
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Affiliation(s)
- Prosanta Mondal
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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