Psychological factors associated with sleep disorders in patients with axial spondyloarthritis or psoriatic arthritis: A multicenter cross-sectional observational study

Abstract

Background: Studies in axial spondyloarthritis (AxSp) have shown that intensity of pain, anxiety, depression and inflammatory activity are associated with poor sleep quality.

Aim: To describe mood and sleep disorders and positive psychological factors in patients with AxSp and psoriatic arthritis (PsA) and to evaluate the psychological factors that are potentially involved in sleep disorders.

Design: Multicenter cross-sectional observational study based on a series of patients with AxSp and PsA.

Participants: Participants were selected consecutively from patients aged ≥18 years with AxSp or PsA followed at the rheumatology department of 4 Spanish hospitals.

Inclusion criteria: age ≥18 years, AxSp (ASAS criteria) or PsA (CASPAR criteria), ability to understand the study and prepared to complete the questionnaires.

Methods: Main outcomes: Oviedo Sleep Quality questionnaire result.

Secondary outcomes: psychological status evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire, health-related quality of life evaluated using SF-36, perception of pain evaluated using the short questionnaire for assessment of pain (BDU) and fatigue evaluated using the Fatigue Scale (FACIT) questionnaire. We performed a descriptive multivariate linear regression analysis to study factors that were independently associated with sleep disorders. The STROBE guidelines were adopted.

Results: We included 301 patients (152 [50.5%] with AxSp and 149 [49.5%] with PsA). The multivariate linear regression analysis for the whole sample showed that insomnia was inversely associated with emotional recovery and biologic disease-modifying antirheumatic drugs and directly associated with depression in both groups. The analysis by disease (AxSp and PsA) showed that insomnia was independently associated with depression and emotional recovery.

Conclusions: Insomnia may be associated with other mood disorders, quality of life and inflammatory activity in the patients studied here.

Relevance to clinical practice: A nurse intervention can be carried out to prevent sleep disorders knowing the consequences and triggers of the problem.

Keywords: association; axial spondyloarthritis; cross-sectional studies; depression; insomnia; mental health; mood disorders; psoriatic arthritis; psychological factors; sleep disorders; spondyloarthritis.