Fatigue and sleep quality in rheumatoid arthritis patients during hospital admission

Psychological resilience and quality of life among middle-aged and older adults hospitalized with chronic diseases: multiple mediating effects through sleep quality and depression

BACKGROUND

The present study is intended to examine the multiple mediating roles of sleep quality and depression in the relationship between psychological resilience and quality of life in middle-aged and older adults hospitalized with chronic diseases.

METHODS

From October 2, 2021, to February 27, 2022, a questionnaire survey was conducted using a multistage stratified sampling method among 339 middle-aged and older adults (45 years and over) hospitalized with chronic diseases. These participants were recruited from a hospital in Zhejiang Province, China. The questionnaire included the Aged Cumulative Disease Rating Scale, the Psychological Resilience Scale, the Pittsburgh Sleep Quality Index Scale, the Depression Scale, and the Quality-of-Life Scale. A descriptive analysis was performed to characterize the sample. Linear regression was utilized to evaluate the relationship between psychological resilience and quality of life. Amos 24.0 was used to analyze the multiple mediated effects of sleep quality and depression.

RESULTS

Psychological resilience exerted a remarkable direct effect on the quality of life in middle-aged and older adults hospitalized with chronic diseases (β = 0.239, 95% CI = 0.125-0.354), which represented 52.98% of the total effect. Through three significantly mediated pathways indirectly affect the quality of life: (1) through the sleep quality pathway (β = 0.115, 95% CI = 0.056-0.201), which represented 25.39% of the total effect; (2) through the depression pathway (β = 0. 060, 95% CI = 0.023-0.114), which represented 13.24% of the total effect; and (3) through both the sleep quality and depression pathway (β = 0. 038, 95% CI = 0.019-0.074), which represented 8.39% of the total effect. The total mediating effect was 47.02%.

CONCLUSIONS

Sleep quality and depression mediate the relationship between psychological resilience and quality of life in middle-aged and older adults hospitalized with chronic diseases. Therefore, healthcare professionals and stakeholders should be concerned about the sleep status and mental health of middle-aged and older adults hospitalized with chronic diseases, strengthen their attention to psychological resilience, and provide interventions and treatment measures for hospitalized patients who have sleep problems and depressive tendencies.

Fatigue in Inflammatory Joint Diseases

Fatigue is a prevalent symptom in various rheumatic diseases, such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. It is characterised as a subjective, enduring feeling of generalised tiredness or exhaustion, impacting the patient's life quality and exacerbating disability. The fatigue nature is multifaceted, encompassing physiological, psychological, and social factors, and although the exact cause of inflammatory joint diseases is not fully understood, several factors are believed to contribute to its development. Despite high prevalence and importance, the symptom is often underestimated in clinical practice. Chronic inflammation, commonly associated with rheumatic diseases, has been proposed as a potential contributor to fatigue development. While current treatments effectively target inflammation and reduce disease activity, fatigue remains a persistent problem. Clinical evaluation of rheumatic diseases primarily relies on objective criteria, whereas fatigue, being a subjective symptom, is solely experienced and reported by the patient. Managing fatigue in inflammatory joint diseases involves a multifaceted approach. Identifying and comprehensively assessing the subjective components of fatigue in individual patients is crucial for effectively managing this symptom in everyday clinical practice.

The Effects of Self-Aromatherapy Massage on Pain and Sleep Quality in Patients with Rheumatoid Arthritis: A Randomized Controlled Trial

BACKGROUND

Rheumatoid arthritis is the most common form of inflammatory arthritis and can lead to pain, joint deformity, and disability, resulting in poor sleep quality and lower quality of life. The efficacy of aromatherapy massage on pain levels and sleep quality among rheumatoid arthritis patients remains unclear.

AIMS

To investigate the effects of aromatherapy on pain and sleep quality among rheumatoid arthritis patients.

METHODS

This randomized controlled trial enrolled 102 patients with rheumatoid arthritis from one regional hospital in Taoyuan, Taiwan. Patients were randomly assigned to the intervention (n = 32), placebo (n = 36), or control groups (n = 34). The intervention and placebo groups underwent self-aromatherapy hand massage guided by a self-aromatherapy hand massage manual and video for 10 minutes 3 times a week for 3 weeks. The intervention group used 5% compound essential oils, the placebo group used sweet almond oil, and the control group had no intervention. Pain, sleep quality and sleepiness were measured by using the numerical rating scale for pain, the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale at baseline and at 1, 2, and 3 weeks after the intervention.

RESULTS

The intervention and placebo groups had significantly decreased sleep quality and sleepiness scores from baseline to 3 weeks after aromatherapy massage. Compared with the control group, the intervention group showed statistically significant improvement in the sleep quality scores in the first weeks after aromatherapy massage (B = -1.19, 95% confidence interval [CI]: -2.35, -0.02, P =.046), but no statistically significant differences were found in the changes in pain levels from baseline to the three time points.

CONCLUSIONS

Aromatherapy massage is effective in improving sleep quality in rheumatoid arthritis patients. More studies are needed to evaluate the effects of aromatherapy hand massage on the pain levels of rheumatoid arthritis patients.

Sleep in hospitalized pediatric and adult patients - A systematic review and meta-analysis

Background

Sleep is essential for recovery from illness. As a result, researchers have shown a growing interest in the sleep of hospitalized patients. Although many studies have been conducted over the past years, an up to date systematic review of the results is missing.

Objective

The objective of this systematic review was to assess sleep quality and quantity of hospitalized patients and sleep disturbing factors.

Methods

A systematic literature search was conducted within four scientific databases. The search focused on synonyms of 'sleep' and 'hospitalization'. Papers written in English or Dutch from inception to April 25th,2022 were included for hospitalized patients >1 year of age. Papers exclusively reporting about patients receiving palliative, obstetric or psychiatric care were excluded, as well as patients in rehabilitation and intensive care settings, and long-term hospitalized geriatric patients. This review was performed in accordance with the PRISMA guidelines.

Results

Out of 542 full text studies assessed for eligibility, 203 were included, describing sleep quality and/or quantity of 17,964 patients. The median sample size of the studies was 51 patients (IQR 67, range 6-1472). An exploratory meta-analysis of the Total Sleep Time showed an average of 7.2 h (95%-CI 4.3, 10.2) in hospitalized children, 5.7 h (95%-CI 4.8, 6.7) in adults and 5.8 h (95%-CI 5.3, 6.4) in older patients (>60y). In addition, a meta-analysis of the Wake After Sleep Onset (WASO) showed a combined high average of 1.8 h (95%-CI 0.7, 2.9). Overall sleep quality was poor, also due to nocturnal awakenings. The most frequently cited external factors for poor sleep were noise and number of patients in the room. Among the variety of internal/disease-related factors, pain and anxiety were most frequently mentioned to be associated with poor sleep.

Conclusion

Of all studies, 76% reported poor sleep quality and insufficient sleep duration in hospitalized patients. Children sleep on average 0.7-3.8 h less in the hospital than recommended. Hospitalized adults sleep 1.3-3.2 h less than recommended for healthy people. This underscores the need for interventions to improve sleep during hospitalization to support recovery.

The Link between the Demographic and Clinical Factors and Fatigue Symptoms among Rheumatoid Arthritis Patients

Rheumatoid arthritis (RA) is a chronic systemic disease of connective tissue with periods of exacerbation and remission. Fatigue is excessive strain throughout the body that is disproportionate or unrelated to an activity or lifestyle. Fatigue is an integral part of RA in most patients. The study aimed to assess the level of fatigue in RA patients and establish the relationship between fatigue and demographic and clinical factors. The study group consisted of 128 RA patients according to European League Against Rheumatism (EULAR) criteria. The Functional Assessment of Chronic Illness Therapy-Fatigue and -Medical Outcomes Study Short Form 36 (SF-36) vitality scores were used to assess the severity of fatigue symptoms. The analyzed variables were gender, age, disease duration, education, marital status, place of residence, work and residence status, pharmacological treatment, pain, morning stiffness, hemoglobin, C-reactive protein (CRP), rheumatoid factor (RF), compression soreness, Richie Articular Index, and DAS28 disease activity. The examined patients experience chronic fatigue-the mean value on the FACIT-F scale was 24.1 ± 9.1 points and on the SF-36 Vitality score was 14.2 ± 1.8 points. There is a relationship between the level of fatigue and pain, long-lasting morning stiffness, active disease, increased soreness of joints, and low hemoglobin values. When analyzing the symptom of fatigue, each patient should be approached individually, using the existing questionnaires or asking key questions to recognize the situation. The presence of fatigue symptoms should be considered during therapy and patient care by searching for and eliminating additional, intensifying stimuli and increasing its level.

Research on the correlation of immunity in patients with chronic insomnia

PURPOSE

To investigate the changes in immunity and clinical infection events among patients with chronic insomnia.

MATERIALS AND METHODS

Forty-two patients with chronic insomnia (age = 64.44 ± 10.53) and 47 normal controls (age = 67.08 ± 7.822) were selected to determine differences in data, such as complete blood counts (CBCs), biochemical indices, lymphocyte subsets, immunoglobulin (Ig), complement C3 and C4 and interleukin-6 (IL-6), as well as to compare the incidence of clinical infection between the two groups.

RESULTS

There were significant differences in erythrocyte, hemoglobin, hematocrit, albumin, globulin, creatinine, IgG, IgG/IgM ratio, CD4⁺ T-lymphocytes, CD19-lymphocytes, CD4⁺/CD8⁺ ratio, platelet/lymphocyte ratio, CD19/CD3 ratio, and clinical infection events between the chronic insomnia group and the control group (p < 0.05). There was no significant difference in neutrophil, lymphocyte, monocyte, and platelet counts; lymphocyte subsets CD8⁺ T and CD56⁺; platelet-to-lymphocyte ratio (PLR); neutrophil-to-lymphocyte ratio (NLR); complement C3; complement C4; IgM; IgA; and IL-6 between the experimental group and their controls (p > 0.05). The systolic and diastolic blood pressures of the chronic insomnia group did not vary widely from those of the controls (p > 0.05).

CONCLUSION

Patients with chronic insomnia have immunological abnormalities, characterized by a higher incidence of clinical infection.

Sleep Problems in Chronic Inflammatory Diseases: Prevalence, Treatment, and New Perspectives: A Narrative Review

Epidemiological studies have shown that individuals with sleep problems are at a greater risk of developing immune and chronic inflammatory diseases. As sleep disorders and low sleep quality in the general population are frequent ailments, it seems important to recognize them as serious public health problems. The exact relation between immunity and sleep remains elusive; however, it might be suspected that it is shaped by others stress and alterations of the circadian rhythm (commonly caused by for example shift work). As studies show, drugs used in the therapy of chronic inflammatory diseases, such as steroids or monoclonal antibodies, also influence sleep in more complex ways than those resulting from attenuation of the disease symptoms. Interestingly, the relation between sleep and immunity appears to be bidirectional; that is, sleep may influence the course of immune diseases, such as inflammatory bowel disease. Thus, proper diagnosis and treatment of sleep disorders are vital to the patient's immune status and, in effect, health. This review examines the epidemiology of sleep disorders and immune diseases, the associations between them, and their current treatment and novel perspectives in therapy.

Association of lifestyle and disease characteristics with self-rated wellness/health score in patients with rheumatoid arthritis

Objective

To study the relationship of self-rated wellness/health and lifestyle in patients with rheumatoid arthritis.

Methods

Self-rated wellness/health, demographics, smoking, mood, sleep, physical activity, diet, symptoms/signs, body mass index and laboratory findings in 142 patients with rheumatoid arthritis were collected in the current cross-sectional study. Multivariable generalized additive model (GAM) was employed to study the association of self-rated wellness/health score and lifestyle factors.

Results

Female/male ratio was 116/26 and the mean (SD) age of sample was 52 (13) years. Mean (SD) self-rated wellness/health score out of 10 was 7.2 (1.63). Mean (SD) number of tender joints and swollen joints were 4.42 (4.55) and 4.00 (4.26), respectively. The mean sleep score was 29.5 out of 70. Patients went to bed more than one hour earlier during the weekdays compared to weekends (22:45 vs. 23:52 PM, respectively, p < 0.0001). They also woke up more than one hour earlier during the weekdays compared to the weekends (6:08 vs. 7:20 AM, respectively, p < 0.0001). Their nap duration during weekdays was about half an hour shorter than the nap duration on weekends (19.75 vs. 48.02 minutes, respectively, p < 0.0001). The mean mood and diet scores were 18.5/35 and 22.5/42, respectively. By backward elimination in multivariable regression model (GAM), disease duration, mood, sleep quality, weekdays sleep characteristics (sleep duration, time to go to bed, wake-up time, time to fall asleep and nap duration), and sleep duration on weekends remained in the final model (R² = 0.225, p = 0.01). Sleep quality, nap duration on weekdays, night sleep duration on weekends and mood status were the significant variables associated with self-rated wellness/health score.

Conclusion

In patients with rheumatoid arthritis, the low self-rated wellness/health score was associated with the low sleep quality, long sleep duration on weekends, and long nap duration on weekdays.

The effect of progressive muscle relaxation on sleep quality and fatigue in patients with rheumatoid arthritis: A randomized controlled trial

AIMS

The aim of this study was to investigate the effects of progressive muscle relaxation on sleep quality and fatigue in patients with rheumatoid arthritis.

METHODS

This randomized controlled study was conducted with 72 patients with rheumatoid arthritis who applied to the rheumatology outpatient clinic of a university hospital between January and May 2018. The data were collected using the Patient Information Form, Pittsburgh Sleep Quality Index and Fatigue Severity Scale. After the patients in the intervention group completed the forms, patients were given training with regard to the application of progressive muscle relaxation which they subsequently performed, and the Pittsburgh Sleep Quality Index and Fatigue Severity Scale forms were repeated after 6 weeks.

RESULTS

After performing progressive muscle relaxation for 6 weeks, the total score of the Pittsburgh Sleep Quality Index and the fatigue score decreased among patients in the intervention group; no change was observed among the patients in the control group. A statistical difference was found between the two groups in terms of the Pittsburgh Sleep Quality Index's and Fatigue Severity Scale's mean scores.

CONCLUSION

Progressive muscle relaxation can be recommended to enhanced sleep quality and reduce fatigue in patients with rheumatoid arthritis.

Influence of successful psychopharmacotherapy of anxiety-depressive spectrum disorders on the severity of chronic fatigue in patients with rheumatoid arthritis

Aim. To assess the influence of psychopharmacotherapy (PPT) of anxiety and depressive disorders on fatigue severity in patients with rheumatoid arthritis (RA). Materials and methods. 128 RA-patients were included. Severity of fatigue was measured with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSS4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with MontgomeryAsberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 сDMARDs (n=39), 2 сDMARDs+PPT (sertraline or mianserine), n=43, 3 сDMARDs+bDMARDs (n=32), 4 сDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 5 years, antidepressants from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Multinominal logistic regression analysis was conducted to determine factors associated with clinically important fatigue. Results. Multinominal logistic regression analysis showed clinically important fatigue at baseline to be positively associated (OR 13.57; 95% CI 3.04460.486; p=0.01) and remission of ADD negatively associated (OR 0.162; 95% CI 0.0320.809; p=0.027), with clinically important fatigue at 5 years follow-up (R2=0.385, p0.0001). Conclusion. Due to significant relationship between mental health status, antidepressants treatment and clinically important fatigue in RA-patients, all patients reporting clinically important fatigue should be recommended mental health counselling by a licensed psychiatrist.

Management of Fatigue in Rheumatoid Arthritis

Fatigue in rheumatoid arthritis is highly prevalent. It is correlated only weakly with disease activity but more so with pain, mood, personality features, poor sleep, obesity and comorbidities. Fatigue can be measured by many standardised questionnaires and more easily with a Visual Analogue Scale or numeric rating scale. Most patients with RA have some fatigue, and at least one in six have severe fatigue. Chronic pain and depressed mood are also common in RA patients with significant fatigue. It affects function and quality of life and is worse on average in women. Evidence-based treatment for fatigue includes treatment of underlying disease activity (with on average modest improvement of fatigue), exercise programmes and supervised self-management programmes with cognitive-behavioural therapy, mindfulness and reinforcement (such as reminders). The specific programmes for exercise and behavioural interventions are not standardised. Some medications cause fatigue such as methotrexate. More research is needed to understand fatigue and how to treat this common complex symptom in RA that can be the worst symptom for some patients.

A biopsychosocial network model of fatigue in rheumatoid arthritis: a systematic review

Fatigue in RA is prevalent, intrusive and disabling. We propose a network model of fatigue encompassing multiple and mutually interacting biological, psychological and social factors. Guided by this model, we reviewed the literature to offer a comprehensive overview of factors that have been associated with fatigue in RA. Six categories of variables were found: physical functioning, psychological functioning, medical status, comorbidities and symptoms, biographical variables and miscellaneous variables. We then systematically reviewed associations between fatigue and factors commonly addressed by rheumatology health professionals. Correlations of fatigue with physical disability, poor mental well-being, pain, sleep disturbance and depression and anxiety were ∼0.50. Mostly these correlations remained significant in multivariate analyses, suggesting partly independent influences on fatigue and differences between individuals. These findings indicate the importance of research into individual-specific networks of biopsychosocial factors that maintain fatigue and tailored interventions that target the influencing factors most relevant to that person.

Disease activity and sleep quality in rheumatoid arthritis: a deeper look into the relationship

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.

Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity

OBJECTIVES

Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarthritis and systemic manifestations. RA-fatigue is a significant problem and adds on disease burden. Sleep disturbance, depression, and disease activity are suggested contributing factors to RA-fatigue; however, their combined role did not examine before among Egyptian RA patients. The objective of the study was to investigate the presence of fatigue, sleep and mood disturbances in RA patients. Also, to evaluate the possible association of poor sleep, depression, and disease activity with RA-fatigue.

METHODS

This cross-sectional study included 115 RA patients diagnosed according to the 2010 ACR-EULAR criteria and 46 age and sex matched controls. Fatigue using the Multidimensional Assessment of Fatigue-Global Fatigue Index, sleep using the Pittsburgh Sleep Quality Index and mood status using Beck Depression Inventory were assessed for all participants. RA disease activity was evaluated using disease activity score-28 joints.

RESULTS

RA patients had higher mean fatigue, sleep disturbance, and depression scores (27.2±8.9, 6.4±3.6, and 12.8±7.3; respectively) than controls (22.7±7, 4.8±3, 7.8±5.9; respectively) (P<.05). Poor sleep, depression and higher disease activity were significantly correlated with fatigue (r=0.4, r=0.65, r=0.55; respectively) (P<.001). The three variables may explain up to 49.1% of the variation in fatigue on multiple regression analysis.

CONCLUSION

Fatigue, poor sleep, and depression are more common in Egyptian patients with RA. A remarkably higher fatigue was associated with poor sleep, depression, and high disease activity, thus monitoring these silent comorbidities in clinical practice is required.