Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms

Natalie Frede; Eva Rieger; Raquel Lorenzetti; Ana C Venhoff; Anna-Maria Kanne; Stephanie Finzel; Ilona Jandova; Cornelia Glaser; Jens Thiel; Reinhard E Voll; Nils Venhoff

doi:10.1136/rmdopen-2022-002912

Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms

RMD Open. 2023 May;9(2):e002912. doi: 10.1136/rmdopen-2022-002912.

Authors

Affiliations

¹ Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany natalie.frede@uniklinik-freiburg.de.
² Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
³ Division of Rheumatology and Clinical Immunology, Medical University Graz, Graz, Austria.

Abstract

Objectives: Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) may have a profound impact on sleep and health-related quality of life. The aim of this study was to assess sleep quality and quality of life and determine associated factors in patients treated with spondyloarthritides (SpA).

Methods: Cross-sectional questionnaire-based assessment of sleep behaviour, quality of life, functional impairment and depression (Regensburg Insomnia Scale, WHO Quality of Life questionnaire, Funktionsfragebogen Hannover questionnaire, Beck Depression Inventory II, Patient health questionnaire 9) and retrospective medical chart analysis of a monocentric cohort of 330 patients with SpA (n=168 PsA and n=162 axSpA).

Results: 46.6% of patients with SpA demonstrated abnormal sleep behaviour. Linear regression models showed HLA-B27 positivity, Bath Ankylosing Spondylitis Disease Activity Index, depressive symptoms, functional capacity and disease duration to be predictive of insomnia symptoms in axSpA, respectively, depressive symptoms, female sex and Disease Activity Score 28 in patients with PsA. Patients with unrestful sleep had a significantly reduced health-related quality of life (p<0.001) as well as significantly more depressive symptoms (p<0.001). Satisfaction with health was rated significantly lower (p<0.001), indicating poor sleep as a burden on general well-being.In particular, female patients had a significantly worse sleep quality with a prolonged sleep latency (p=0.009), increased sleep disturbances (p=0.014) and unrestful sleep (p<0.001) as well as a reduced physical and mental health-related quality of life (p=0.015, p<0.001) and more depressive symptoms (p=0.015).

Conclusion: Despite treatment, many patients with SpA demonstrate abnormal sleep behaviour with symptoms of insomnia and a reduced quality of life with significant differences between male and female patients. An interdisciplinary and holistic approach may be needed to address unmet needs.

Keywords: Arthritis, Psoriatic; Patient Reported Outcome Measures; Spondylitis, Ankylosing; Therapeutics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthritis, Psoriatic* / complications
Arthritis, Psoriatic* / epidemiology
Axial Spondyloarthritis*
Cross-Sectional Studies
Depression / epidemiology
Depression / etiology
Female
Humans
Male
Quality of Life
Retrospective Studies
Sleep
Sleep Initiation and Maintenance Disorders* / epidemiology
Sleep Initiation and Maintenance Disorders* / etiology
Spondylarthritis* / complications
Spondylarthritis* / diagnosis
Spondylarthritis* / epidemiology
Spondylitis, Ankylosing*