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.

Ability to Participate in Social Activities of Rheumatoid Arthritis Patients Compared with Other Rheumatic Diseases: A Cross-Sectional Observational Study

“…This finding is consistent with those of other studies of RA, which found an association between increased inflammatory activity and pain, anxiety, depression, and quality of life [ 33 ]. In SpA, inflammatory activity measured using the BASDAI was also associated with greater depression, anxiety, and sleep disorders [ 3 ]; therefore, control of inflammation could improve these psychological factors, even participation in social activities. However, this does not seem to be the case in patients with SLE, since we found no association between SLEDAI values and participation in social activities; associations were found only for satisfaction with social roles, mobility, and emotional support.…”

“…Rheumatic diseases, such as rheumatoid arthritis (RA), spondyloarthritis (SpA), and systemic lupus erythematosus (SLE), are characterized by joint inflammation and other systemic manifestations that lead to functional disability and impaired quality of life [ 1 ]. The therapeutic objectives in affected patients include not only reducing inflammatory activity, but also improving quality of life and participation in social activities [ 2 , 3 ]. Previous studies have shown that participation in social activities is closely related to better quality of life and well-being [ 4 ].…”

Longitudinal Study of Cognitive Functioning in Adults with Juvenile Idiopathic Arthritis

“…Problems affecting concentration and executive functions may be caused by a depressive state, and this could lead to cognitive impairment [ 9 ]. Furthermore, in patients with inflammatory arthritis and autoimmune diseases, the frequency of depression has been reported to be increased [ 4 , 42 , 43 , 44 ], possibly as a result of various mechanisms, such as high levels of inflammatory mediators that negatively affect monoaminergic neural transmission, maintenance of synaptic plasticity, and physical inability to carry out activities of daily living owing to pain and inflammation [ 4 ]. In patients with JIA, fatigue and sleep problems are common [ 45 ].…”

Psoriatic arthritis: one year in review 2022

“…Involvement of sleep quality may often be observed in PsA. Data from a Spanish multicentre study investigating sleep disorders in patients with Ax-SpA and PsA showed that mood disorders (in particular depression), poor QoL and active disease seemed to be risk factors for the development of insomnia (39). On the contrary, data from a multicentre observational study, underlined that pain and anxiety were the major determinants of sleep impairment in PsA, independently of disease activity (40).…”

“…• Disease activity, disease duration and chronic pain seem to significantly impact on the occurrence of fatigue in PsA patients (37,38); • Sleep impairment in PsA could be associated with mood disorder; whether disease activity has a significant role in its development is still unclear (39,40).…”