Sleep disturbances in chronic rheumatic diseases: Is disease activity the major determinant factor?

Sleep disturbances are closely related to chronic pain processes, especially in patients with inflammatory and mechanical joint diseases.

This study aims to report sleep characteristics in patients with rheumatoid arthritis (RA) and knee osteoarthritis also to determine the responsibility of disease activity in the occurrence of sleep disturbances during chronic rheumatic diseases.

We conducted a comparative study between two groups of patients: the first with RA, the second with primary knee osteoarthritis. We reported sociodemographic and medical data (clinical and biological inflammatory syndrome data). Then, we assessed depression, anxiety, and sleep disturbances with respectively Beck Depression Inventory, Beck Anxiety Inventory and Medical Outcome Study Sleep Scale (MOS-SS).

Seventy RA patients aged 51.9 years, with an average of 77.1% female were studied. The mean disease duration was 6.9 years. All sleep domains were altered in these patients. Forty patients with knee osteoarthritis aged 57.5 years with an average of 70% female were included. The mean disease duration was 4 years. The most impaired domains in this group were somnolence and sleep disturbance. Multivariate analysis concluded that risk factors independently related to RA were:  disease activity score, functional disability, depression, anxiety, and body mass index. Disease activity score were the only parameter to influence all domains of sleep.

So we result that disease activity is a risk factor independently related to sleep disturbances in rheumatoid arthritis. Furthermore, mood disorders and obesity also deteriorate several sleep domains. These factors must be considered in the management of chronic rheumatic disorders.