Sleep Disorders Among Individuals With Rheumatoid Arthritis

Abstract

Objective Self‐reported sleep problems are common in rheumatoid arthritis (RA), with potential negative health implications, yet relatively little research has focused on sleep in RA. We examined the prevalence of obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS) symptoms, and short sleep (SS) in a large RA cohort (n = 4,200) and factors associated with each. Methods Data are from FORWARD, The National Databank for Rheumatic Diseases. Validated screening measures assessed OSA risk and RLS symptoms. SS was based on self‐reported average sleep time (<6 hours). The Medical Outcomes Study Sleep Problems Index I measured self‐reported sleep quality. Multivariable logistic regression models identified independent predictors of sleep disorders and sleep quality and the independent association of OSA risk, RLS symptoms, and SS with self‐reported poor sleep quality. Results Twenty‐one percent (n = 899) had OSA diagnosis or risk, 30% (n = 1,272) had RLS symptoms or diagnosis, and 43% (n = 1,737) reported SS, and RA disease activity was associated with each sleep disorder. Abatacept use was associated with lower odds of RLS and SS. Use of conventional disease‐modifying antirheumatic drugs or abatacept was less frequent in the SS group. No medications were associated with OSA in multivariable analyses. Both RLS and SS was associated with worse perceived sleep quality. Discussion Almost two‐thirds met criteria for at least one sleep disorder. RA disease activity and pain were significantly associated with each sleep condition. Additional research is needed to identify the causal pathway between sleep disorders and RA disease activity and pain and the long‐term consequences of sleep disorders in RA.

Sleep‐related disorders in adults with rheumatoid arthritis: comment on article by Katz et al

“…We thank Chen et al for their careful attention to our article, Sleep Disorders Among Individuals With Rheumatoid Arthritis (1,2). We agree there are covariates that may affect the presence of sleep disorders for which we were unable to account.…”

Major adverse cardiovascular events and mortality with opioids versus NSAIDs initiation in patients with rheumatoid arthritis

“…Although this has not been extensively studied for other medications, it is possible that they can delay absorption and effectiveness of other CVD risk-reducing medications and even DMARDs. Another noted risk with opioids is the exacerbation of sleep-disordered breathing which is common in RA43 and can cause arrythmias, myocardial ischaemia and sudden death 44 45. This may also be contributing to increased all-cause mortality with opioids in addition to unintentional overdose, sedation, falls and accidents 19.…”

Prevalence of Poor Sleep Quality and Associated Factors in Individuals with Rheumatoid Arthritis: A Cross-Sectional Study

“…Manifestations of rheumatoid arthritis are not limited to joint stiffness and pain; they could affect other organs and cause systemic effects such as pulmonary fibrosis, neuropathy, and pericarditis [ 6 ]. In addition, patients with this disease have several factors that may contribute to RA’s manifestations, including disorders such as psychological problems or sleep disturbances [ 6 , 7 ] such as difficulty falling asleep, poor-quality sleep, non-restorative sleep, wakefulness, awakening during the night, and excessive daytime sleepiness [ 3 , 8 ]. Several studies have shown that sleep disturbances appear in 54% to 70% of individuals with rheumatoid arthritis; therefore, problems related to sleep quality are an important issue among these patients [ 9 , 10 ].…”

“…Several studies have shown that sleep disturbances appear in 54% to 70% of individuals with rheumatoid arthritis; therefore, problems related to sleep quality are an important issue among these patients [ 9 , 10 ]. Previous meta-analyses investigating sleeping patients with rheumatoid arthritis, including studies in Turkey, Korea, China, the USA, Malaysia, and Sweden, found an increased risk of sleep disturbances among people with rheumatoid arthritis [ 7 , 11 ].…”

“…Sleep problems increase with disease duration, but reductions in sleep quality relate more to pain and functional impairment [ 13 ]. Possible causes of sleep disturbances in RA include inflammatory disease activity, joint pain, sleep apnea, restless leg syndrome, fatigue, a decreased quality of life, and psychological disorders such as depression [ 7 , 10 , 14 ]. The prevalence of depression in individuals with rheumatoid arthritis ranges between 14% and 48%.…”