The evaluation of sleep quality and response to anti-tumor necrosis factor α therapy in rheumatoid arthritis patients

Abstract

Poor sleep quality (SQ) is increasingly recognized as giving rise to decreased quality of life, and raising pain perception. Our aim is to evaluate the SQ in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor alpha (anti-TNF-α) therapy. This was a prospective observational and open-label study of RA patients. A total of 35 patients with RA were enrolled in this study. Of the 35 patients, 22 had high disease activity (DA), and 13 were in remission. High DA group was initiated an anti TNF-α therapy. Clinical and objective parameters of SQ were assessed by using the Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG). The total PSQI score and the frequency of poor SQ were high in 60 % of the RA patients. The median PSQI score was significantly higher in the high DA group than in the remission group (P = 0.026). Following an anti-TNF-α therapy initiation, significant improvements were observed in the high DA group by PSQI test (P = 0.012). However, no statistically significant difference was found by PSG (P > 0.05). Although an improvement in DA with anti-TNF-alpha therapy did not provide an amelioration in laboratory parameters, we found a significant improvement in SQ by subjective PSQI test. These findings may support that sleep disorders in RA are likely to be associated with a complex pathophysiology.

The Sleep-Immune Crosstalk in Health and Disease

“…Appropriate dosage and timing of medications or medication change should be considered to keep associated sleep-disturbing effects at a minimum.In disorders characterized by immune dysregulations, immune-therapy may not only be used to improve disease activity, but also to directly improve sleep. As described in section II D2 , treatment of RA patients with IL-6 or TNF blockers improved sleep (196, 283, 535). Comparable effects of anti-TNF therapy on sleep were found in patients with IBD and ankylosing spondylitis (282, 527).…”

“…In a large cohort of over 8,000 patients from the National Data Bank of Rheumatic Diseases, self-reported sleep disturbances, including trouble falling asleep, trouble getting back to sleep, and not getting enough sleep to feel rested, did not differ between those who received anti-TNF therapy and those who did not (587). In contrast, treatment with anti-TNF therapy in RA patients with high disease activity resulted in an improvement of self-reported sleep quality, without affecting PSG-derived sleep parameters (283). However, at least three studies reported PSG-derived sleep improvements in response to anti-TNF therapy.…”

Measures of Sleep in Rheumatologic Diseases: Sleep Quality Patient‐Reported Outcomes in Rheumatologic Diseases

“…The PSQI is a legacy instrument that has been used to study prevalence of poor sleep and associated factors in a wide range of patients with rheumatologic diagnoses, including systemic lupus erythematosus (SLE) (30–32), RA (33–36), spondyloarthritides (37–39), systemic sclerosis (28,33), Sjögren syndrome (40,41), osteoarthritis (42–44), and fibromyalgia (45,46). It may not be able to detect well‐known disturbances of sleep that accompany aging (25).…”

Objective and Subjective Sleep in Rheumatoid Arthritis and Severe Seasonal Allergy: Preliminary Assessments of the Role of Sickness, Central and Peripheral Inflammation

“…6 Similarly, selfreported sleep quality has by others been reported to be lower in RA, 17 and studies with objective measures of sleep showed more sleep fragmentation and more sleep apnea in RA patients compared to healthy controls. 16,18,19 Disturbed sleep has also been shown to covary with pain in patients with RA, 16 and similarly, apnea and nasal congestion in allergy might impair sleep. 9,16 Across a number of different patient and healthy populations, subjective sleep disturbances as well as long and short sleep durations, compared to normal, are associated with higher levels of interleukin (IL)-6 and C-reactive protein.…”