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07-03-2018 | Ankylosing spondylitis | Article

Prevalence and factors associated with disturbed sleep in outpatients with ankylosing spondylitis

Journal: Clinical Rheumatology

Authors: Anliu Nie, Chen Wang, Yuqing Song, Xia Xie, Hui Yang, Hong Chen

Publisher: Springer London

Abstract

Sleep disturbance is prevalent among patients with ankylosing spondylitis (AS) and is considered a multifactorial issue. The study was designed to investigate sleep disturbance and its associated factors in AS outpatients in Southwest China. Patients were recruited by convenience sampling in this cross-sectional study. The Pittsburgh Sleep Quality Index (PSQI), the Bath AS Disease Activity Index (BASDAI), the Bath AS Functional Index (BASFI), the Bath AS Patient Global Score (BAS-G), and the Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality, disease activity, function status, global well-being, depression, and anxiety. Spearman’s correlation, t test, ANOVA, and multiple linear regression analysis were used to explore the associated factors of sleep disturbance. Of the 281 outpatients included in the study, 190 (67.6%) patients had sleep disturbance. The married patients, the patients with extra-spinal manifestation, depression and anxiety, longer duration of diagnostic delay, higher disease activity, worse functional status and global well-being, high level of pain, and fatigue, had poorer sleep quality (P < 0.05). Multiple linear regression analysis revealed age (β = 0.087, P = 0.102), BAS-G (β = 0.181, P = 0.003), fatigue (β = 0.170, P = 0.002), anxiety (β = 0.151, P = 0.002) and nocturnal back pain (β = 0.192, P = 0.001), extra-spinal manifestation (β = 0.120, P = 0.012), and duration of diagnostic delay (β = 0.174, P = 0.001) were the contributors to PSQI. Sleep disturbance is common in AS patients in Southwest China. It may be useful to keep regular exercise, strengthen the management of pain, relieve anxiety, and prevent and treat extra-spinal manifestation for improving sleep quality.
Literature
1.
Aydin E, Bayraktar K, Turan Y, Omurlu I, Tastaban E, Sendur OF (2015) Sleep quality in patients with ankylosing spondylitis. Rev Bras Reumatol 55(4):340–345CrossRefPubMed
2.
Abdulaziez O, Asaad T (2012) Sleep problems in ankylosing spondylitis: polysomnographic pattern and disease related variables. Egypt Rheumatol 34(2):59–65CrossRef
3.
Farren W, Goodacre L, Stigant M (2013) Fatigue in ankylosing spondylitis: causes, consequences and self-management. Musculoskeletal Car 11(1):39–50CrossRef
4.
Jamieson AH, Alford CA, Bird HA, Hindmarch I, Wright V (1995) The effect of sleep and nocturnal movement on stiffness, pain, and psychomotor performance in ankylosing spondylitis. Clin Exp Rheumatol 13(1):73–78PubMed
5.
Dagfinrud HKI, Mowinckel PHKB, Kvien TK (2005) Impact of functional impairment in ankylosing spondylitis: impairment, activity limitation, and participation restrictions. J Rheumatol 32(3):516–523PubMed
6.
Ates A, Dortbas F, Karaaslan Y (2015) The relationship between disease activity, functional index, sleep quality, anxiety, depression, fatigue and quality of life in patients with ankylosing spondylitis. Ann Rheum Dis 74(Suppl2):497–498
7.
Li Y, Zhang S, Zhu J, Du X, Huang F (2012) Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study. Arthritis Res Ther 14(5):R215CrossRefPubMedPubMedCentral
8.
Hakkou J, Rostom S, Mengat M, Aissaoui N, Bahiri R, Hajjaj-Hassouni N (2013) Sleep disturbance in Moroccan patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status and quality of life. Rheumatol Int 33(2):285–290CrossRefPubMed
9.
Abad VC, Sarinas PSA, Guilleminault G (2008) Sleep and rheumatologic disorders. Sleep Med Rev 12(3):211–222CrossRefPubMed
10.
Yolbaş S, Yıldırım A, Düzenci D, Gündoğdu B, Özgen M, Koca SS (2017) Sleep quality, sleeping postures, and sleeping equipment in patients with ankylosing spondylitis. Turk J Med Sci 47(4):1198–1205CrossRefPubMed
11.
Kim HJ, Kim JH, Park KD, Choi KG, Lee HW (2011) A survey of sleep deprivation patterns and their effects on cognitive functions of residents and interns in Korea. Sleep Med 12(4):390–396CrossRefPubMed
12.
Neckelmann D, Mykletun A, Dahl AA (2007) Chronic insomnia as a risk factor for developing anxiety and depression. Sleep 30(7):873–880CrossRefPubMedPubMedCentral
13.
Shen TC, Liang SJ, Lin CL, Tu CY, Hsia TC, Shih CM (2016) Ankylosing spondylitis and the subsequent risk of sleep disorders: a retrospective population-based cohort study in Taiwan. J Intern Med 27(2):79–88
14.
Mitchell AMB (2008) Modifying cancer-related fatigue by optimizing sleep quality. J Natl Compr Cancer Netw 6(1):3–13CrossRef
15.
Batmaz İ, Sarıyıldız MA, Dilek B, Bez Y, Karakoç M, Çevik R (2013) Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatol Int 33(4):1039–1045CrossRefPubMed
16.
Heiberg T, Lie E, van der Heijde D, Kvien TK (2011) Sleep problems are of higher priority for improvement for patients with ankylosing spondylitis than for patients with other inflammatory arthropathies. Ann Rheum Dis 70(5):872–873CrossRefPubMed
17.
Hultgren S, Broman JE, Gudbjörnsson B, Hetta J, Lindqvist U (2000) Sleep disturbances in outpatients with ankylosing spondylitisa questionnaire study with gender implications. Scand J Rheumatol 29(6):365–369CrossRefPubMed
18.
Rudwaleit M, Gooch K, Michel B, Herold M, Thörner A, Wong R, Kron M, Chen N, Kupper H (2010) Adalimumab improves sleep and sleep quality in patients with active ankylosing spondylitis. J Rheumatol 38(1):79–86CrossRefPubMed
19.
Jeong HJ, Lee TH, Ji ML, Choi G, Son CN, Kim JM (2014) Sleep disturbances in Korean patients with ankylosing spondylitis are associated with increased disease activity. J Rheum Dis 21(5):241–247CrossRef
20.
Zou Q, Jiang Y, Mu F, Shi Y, Fang Y (2016) Correlation of axial spondyloarthritis with anxiety and depression. Med Sci Monit 22:3202–3208CrossRefPubMedPubMedCentral
21.
Cherif I, Hamdi W, Kaffel D, Zouch I, Kchir M (2014) Correlation between sleep disturbance, fatigue and psychological features in patients with ankylosing spondylarthritis. Ann Rheum Dis 73(Suppl 2):1035
22.
Aissaoui N, Rostom S, Hakkou J, Berrada Ghziouel K, Bahiri R, Abouqal R, Hajjaj-Hassouni N (2012) Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance. Rheumatol Int 32(7):2117–2124CrossRefPubMed
23.
Van der Linden S, Valkenburg H, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York. Arthritis Rheum 27:361–368CrossRefPubMed
24.
Buysse DJ, Rd RC, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213CrossRefPubMed
25.
Liu XC, Tang MQ, Hu L (1996) Reliability and validity of the Pittsburgh Sleep Quality Index. Chin J Psychiatry 2:103–107
26.
Garrett S, Jenkinson T, Kenned LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291PubMed
27.
Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21(12):2281–2285PubMed
28.
Jones SD, Steiner A, Garrett SL, Calin A (1996) The Bath Ankylosing Spondylitis Patient Global Score (BAS-G). Br J Rheumatol 35(1):66–71CrossRefPubMed
29.
Zigmond AS, Snaith PR (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370CrossRefPubMed
30.
Ye WF, Xu JM (1993) The application and evaluation of the hospital anxiety and depression scale in general hospital patients. Chin J Behav Med Brain Sci 3:17–19
31.
Leverment S, Clarke E, Wadeley A, Sengupta R (2017) Prevalence and factors associated with disturbed sleep in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review. Rheumatol Int 37(2):1–15CrossRef
32.
Gadie A, Shafto M, Leng Y, Kievit RA, Cam-CAN (2017) How are age-related differences in sleep quality associated with health outcomes? An epidemiological investigation in a UK cohort of 2406 adults. BMJ Open 7(7):e014920CrossRefPubMedPubMedCentral
33.
Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC (2010) Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med 11(9):934–940CrossRefPubMedPubMedCentral
34.
Jiang Y, Yang M, Wu H, Song H, Zhan F, Liu S, Gao G, Liu Z, Hu Z, He P, Zhang S, Hu Z, Lin Z, Zhang Y, Li Y, Shen L, Huang A, Liao Z, Cao S, Wei Y, Li L, Li Q, Lv Q, Qi J, Huang J, Li T, Jin O, Pan Y, Gu J (2015) The relationship between disease activity measured by the BASDAI and psychological status, stressful life events, and sleep quality in ankylosing spondylitis. Clin Rheumatol 34(3):503–510CrossRefPubMed
35.
Zhang SL, Li Y, Zhu J, Huang ZF, Zhang JL, Huang F (2013) Relationship between sleep quality and nocturnal pain in ankylosing spondylitis. Natl Med J China 93(13):970–972
36.
Deodhar ABJ, Inman RDMM, BJea PS (2010) Golimumab reduces sleep disturbance in patients with active ankylosing spondylitis: results from a randomized, placebo-controlled trial. Arhritis Care Res 62:1266–1271CrossRef
37.
Billington J, Farrington G, Lampropoulou S, Lingwood J, Jones A, Ledson J, et al (2016) A comparative study of cognitive behavioural therapy and shared reading for chronic pain. Med Humanit: medhum-2016-011047
38.
Ramiro S, Radner H, van der Heijde DM, Buchbinder R, Aletaha D, Landewé RB (2012) Combination therapy for pain management in inflammatory arthritis: a Cochrane systematic review. J Rheumatol Suppl 90:47–55CrossRefPubMed
39.
Da CD, Zummer M, Fitzcharles MA (2009) Determinants of sleep problems in patients with spondyloarthropathy. Musculoskeletal Care 7(3):143–161CrossRef
40.
Morphy H, Dunn KM, Lewis M, Boardman HF, Croft PR (2007) Epidemiology of insomnia: a longitudinal study in a UK population. Sleep 30(3):274–280PubMed
41.
Gregory AM, Caspi A, Eley TC, Moffitt TE, Oconnor TG, Poulton R (2005) Prospective longitudinal associations between persistent sleep problems in childhood and anxiety and depression disorders in adulthood. J Abnorm Child Psychol 33(2):157–163CrossRefPubMed
42.
El Maghraoui A (2011) Extra-articular manifestations of ankylosing spondylitis: prevalence, characteristics and therapeutic implications. Eur J Intern Med 22(6):554–560CrossRefPubMed
43.
Purabdollah M, Lakdizaji S, Rahmani A, Hajalilu M, Ansarin K (2015) Relationship between sleep disorders, pain and quality of life in patients with rheumatoid arthritis. J Caring Sci 4(3):233–241CrossRefPubMedPubMedCentral
44.
Dincer U, Cakar E, Kiralp MZ, Dursun H (2008) Diagnosis delay in patients with ankylosing spondylitis: possible reasons and proposals for new diagnostic criteria. Clin Rheumatol 27(4):457–462CrossRefPubMed
45.
Machado MA, Barbosa MM, Almeida AM, de Araújo VE, Kakehasi AM, Andrade EI et al (2013) Treatment of ankylosing spondylitis with TNF blockers: a meta-analysis. Rheumatol Int 33(9):2199–2213CrossRefPubMed
46.
Ibn YY, Amine B, Laatiris A, Bensabbah R, Hajjaj-Hassouni N (2012) Relationship between diagnosis delay and disease features in Moroccan patients with ankylosing spondylitis. Rheumatol Int 32(2):357–360CrossRef
47.
Brophy S, Davies H, Dennis MS, Cooksey R, Husain MJ, Irvine E, Siebert S (2013) Fatigue in ankylosing spondylitis: treatment should focus on pain management. Semin Arthritis Rheum 42(4):361–367CrossRefPubMed