Sleep problems in rheumatoid arthritis over 12 years from diagnosis: results from the Swedish EIRA study

Most studies of rheumatoid arthritis (RA) and sleep have focused on established RA. We here investigate sleep quality and sleep duration in patients with newly diagnosed RA and during 1-12 years after diagnosis.

Data were collected on sleep 1-12 years after diagnosis from patients diagnosed 1998-2018 in the Swedish study Epidemiological Investigation of RA. Six sleep domains (sleep problems, non-restorative sleep, insomnia, insufficient sleep, sleep quality perceived as poor and sleep considered a health problem); a global sleep score and time spent in bed were estimated. Using logistic regression, ORs were calculated for each sleep outcome by disease duration. We explored whether pain (low (Visual Analogue Scale=0-20 mm, reference), intermediate=21-70, high=71-100) or functional impairment (Health Assessment Questionnaire>1.0) was associated with problems.

We had sleep data on 4131 observations (n=3265 individuals). Problems with ≥1 sleep domain (global sleep score) was reported in 1578 observations (38%) and increased with disease duration (OR 1.04, 95% CI 1.02 to 1.07). Median time in bed was 8 hours (Q1-Q3: 7.5-9.0). High-grade pain increased the likelihood of sleep problems ~3-9 fold, and increased functional impairment ~4-8 fold.

In this cohort of newly diagnosed patients with RA with access to the current treatment from diagnosis, we did not find any major problems with sleep, and existing sleep problems related mainly to pain and reduced function. Treatment of sleep problems in RA should be guided towards treating the underlying problem causing the sleep disturbance.