Association of sleep disturbance with calcitonin, disease severity and health index among patients with ankylosing spondylitis

Abstract

To investigate the association of sleep disturbance with calcium regulatory hormones, disease severity and health index among the patients with ankylosing spondylitis (AS).There were 104 AS patients enrolled in the cross-sectional study, and their sleep quality was recorded. Serum levels of calcium, parathyroid hormone, vitamin D3 and calcitonin were measured. We evaluated patient's disease activity, functional ability, patient's global assessment, physical mobility, radiographic damage and health index. Blood ESR and CRP levels were tested.Sleep quality was positively correlated with serum calcitonin levels (r = 0.260, P = .008). Bad sleep and advanced radiographic damage were found among the AS patients with detectable serum calcitonin levels (P < .05). Sleep quality was significantly correlated with disease duration, CRP, BASDAI, ASDAS-ESR, ASDAS-CRP, BASFI, BAS-G, BASMI and ASAS-HI among the AS patients (all P < .05). Female gender, longer disease duration, higher ASDAS-CRP and serum calcitonin levels (OR [95% CI] = 3.210 [1.012-10.181], P = .048) were independent factors associated with bad sleep. Inflammation, disease activity, functional ability, patient's global assessment and cervical rotation were useful in predicting bad sleep among the AS patients, and ASDAS-CRP was the best predictor (AUC = 0.772, P < .001).Serum calcitonin levels was elevated in the AS patients with bad sleep, and may participate in the pathophysiology of sleep disturbance. Bad sleep was associated with female gender, longer disease duration, higher inflammation, disease activity, functional impairment, mobility restriction, poor patient's global assessment and health index in AS. ASDAS-CRP was best in predicting bad sleep.

Prevalence of sleep disturbance in patients with ankylosing spondylitis: a systematic review and meta-analysis

“…Similarly, and even more sternly, sleep disorders affect the quality of life of AS patients [6]. The findings of existing research highlight the role of sleep disorder in the occurrence of depression and anxiety [16,20,22] and fatigue [20,27] and that there is a significant positive relationship between sleep disorder and AS [6,28].…”

“…Inflammation in AS can cause bone erosion, new bone formation, and excessive bone remodeling and slowly fills the interarticular spaces and eventually fuses the joints in the spine, which triggers severe pain and reduces spinal mobility and stiffness [1][2][3][4][5][6]. This bone destruction and misplaced growth lead to major limitations in spine mobility, physical activity, and impaired functional ability.…”

“…This bone destruction and misplaced growth lead to major limitations in spine mobility, physical activity, and impaired functional ability. [5,6]. In addition, these patients are at a greater risk of suffering from depression and anxiety [7,8].…”

“…Sleep disorders in AS patients can be influenced by the experience of axial pain and inflammatory back pain after midnight [20,21], severeness of the disease [10], and fatigue and functional limitations experienced by the patients [6,20]. In addition, under the influence of symptoms and complications of the disease, these patients experience anxiety and depression, which can affect sleep quality [16,20,[22][23][24].…”

“…Accordingly, sleep disorders are related to increasing the risk of impaired cognitive functions, signs of depression, sleepiness during the day, and thus increasing the probability of accidents, falls and related deaths, fatigue, and reducing the physical capacity of a person in performing daily activities [12,26]. Similarly, and even more sternly, sleep disorders affect the quality of life of AS patients [6]. The findings of existing research highlight the role of sleep disorder in the occurrence of depression and anxiety [16,20,22] and fatigue [20,27] and that there is a significant positive relationship between sleep disorder and AS [6,28].…”