The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis

Abstract

The objective of this paper is to assess the contribution of disease activity, pain, and psychological factors to self-reported sleep disturbance in patients with rheumatoid arthritis (RA), and to evaluate whether depression mediates the effects of pain on sleep disturbance. The sample included 106 patients with confirmed RA participated in an assessment of their disease activity, pain, psychological functioning, and sleep disturbance during a baseline evaluation prior to participating in a prospective study to help them manage their RA. Self-measures included the Rapid Assessment of Disease Activity in Rheumatology (RADAR), the SF-36 Pain Scale, the Helplessness and Internality Subscales of the Arthritis Helplessness Index (AHI), the Active and Passive Pain Coping Scales of the Pain Management Inventory (PMI), the Center for Epidemiological Studies Depression Scale (CES-D), and the Pittsburgh Sleep Quality Index (PSQI). Hierarchical multiple regression analysis confirmed that higher income, pain, internality, and depression contributed independently to higher sleep disturbance. A mediational analysis demonstrated that depression acted as a significant mechanism through which pain contributed to sleep disturbance. Cross-sectional findings indicate that pain and depression play significant roles in self-reported sleep disturbance among patients with RA. The data suggest the importance of interventions that target pain and depression to improve sleep in this medical condition.

A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study

“…Depression in RA has been linked to an increased risk for other comorbidities and an elevated mortality 48,49 . Nicassio, et al 50,51 , has demonstrated the complex interplay of increased pain perception, sleep disturbance, helplessness, and depression in RA. Given the frequent co-occurrence of depression among patients with RA, an intervention with sustainable benefit in depressive symptoms may produce sustainable health benefits in the long term.…”

Emotions related to participation restrictions as experienced by patients with early rheumatoid arthritis: a qualitative interview study (the Swedish TIRA project)

“…They already experienced sleeping problems and were afraid of this increasing. RA research has shown that pain and depression play a significant role in sleep disturbance [35]. However, sleeping problems might also be related to the current social situation and worries about work capacity and economic situation.…”

Pain in systemic inflammatory rheumatic diseases

“…Widespread reductions in pain pressure thresholds have been associated with moodiness and sleep disturbances [54,55], and cross-sectional surveys have found that about 8% of RA patients satisfy the FM classification criteria [56,57]. However, although these criteria may identify the subgroup of patients with the most abnormal pain processing, they may conceal the larger number of patients whose symptoms are due to similar pain mechanisms.…”