Sleep Problems in Patients With Psoriatic Arthritis: A Systematic Literature Review and Metaanalysis

Abstract

The aim of this systematic review and meta-analysis is to summarize evidence regarding the relationship between psoriatic arthritis (PsA) and sleep problems. We identified 36 eligible studies (26 cross-sectional, 7 cohort and 3 interventional) in PubMed and EMBASE. The prevalence of self-reported sleep problems in patients with PsA ranged from 30-85%. Meta-analysis of six studies that used the Pittsburgh Sleep Quality Index (PSQI) revealed a prevalence of poor sleep quality for patients with PsA of 72.9% [95%CI 63- 81.8; I2:78%], statistically higher than in healthy controls (HC) (26.9% [11.7-45.4; I2: 81%]) but not significantly different than patients with psoriasis (PsO) (59.8% [46.9-72.1; I2: 51%]). Sleep disturbance was ranked in the top 4 health-related quality of life domains affected by PsA. One study suggested a bidirectional relationship between PsA and obstructive sleep apnea. Predictors of sleep problems included anxiety, pain, erythrocyte sedimentation rate, depression, fatigue, physical function, and tender/swollen joint count. TNF-inhibitors, guselkumab, and filgotinib (a JAK-inhibitor) were associated with improved sleep outcomes. Objective sleep measures (i.e., actigraphy and polysomnography) have not been used in PsA studies, and evidence on the validity of patient-reported sleep measures in PsA is lacking. In summary, poor sleep quality is prevalent in patients with PsA. Future studies should validate self-reported sleep measures in PsA, explore how sleep quality relates to PsA disease activity and symptoms using both objective and subjective sleep measures, assess the efficacy of strategies to manage sleep problems, and the effects of such management on symptoms and disease signs in patients with PsA.