Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms

Abstract

Objectives: Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) may have a profound impact on sleep and health-related quality of life. The aim of this study was to assess sleep quality and quality of life and determine associated factors in patients treated with spondyloarthritides (SpA).

Methods: Cross-sectional questionnaire-based assessment of sleep behaviour, quality of life, functional impairment and depression (Regensburg Insomnia Scale, WHO Quality of Life questionnaire, Funktionsfragebogen Hannover questionnaire, Beck Depression Inventory II, Patient health questionnaire 9) and retrospective medical chart analysis of a monocentric cohort of 330 patients with SpA (n=168 PsA and n=162 axSpA).

Results: 46.6% of patients with SpA demonstrated abnormal sleep behaviour. Linear regression models showed HLA-B27 positivity, Bath Ankylosing Spondylitis Disease Activity Index, depressive symptoms, functional capacity and disease duration to be predictive of insomnia symptoms in axSpA, respectively, depressive symptoms, female sex and Disease Activity Score 28 in patients with PsA. Patients with unrestful sleep had a significantly reduced health-related quality of life (p<0.001) as well as significantly more depressive symptoms (p<0.001). Satisfaction with health was rated significantly lower (p<0.001), indicating poor sleep as a burden on general well-being.In particular, female patients had a significantly worse sleep quality with a prolonged sleep latency (p=0.009), increased sleep disturbances (p=0.014) and unrestful sleep (p<0.001) as well as a reduced physical and mental health-related quality of life (p=0.015, p<0.001) and more depressive symptoms (p=0.015).

Conclusion: Despite treatment, many patients with SpA demonstrate abnormal sleep behaviour with symptoms of insomnia and a reduced quality of life with significant differences between male and female patients. An interdisciplinary and holistic approach may be needed to address unmet needs.

Keywords: Arthritis, Psoriatic; Patient Reported Outcome Measures; Spondylitis, Ankylosing; Therapeutics.

Figure 1

Sleep behaviour. (A) Overview of different items describing sleep behaviour. (B) Patients with axial involvement (light blue bars) show more abnormal sleep behaviour with early awakening, unrefreshing sleep and need for sleeping pills to fall asleep. (C) Patients with unrefreshing sleep (shown in dark grey) have more depressive symptoms, a worse subjective quality of life and a lower satisfaction with their own health. *p≤0.05; **p≤0.01; ***, p≤0.001; ****p≤0.0001. BDI-II, Beck Depression Inventory II; RIS, Regensburg Insomnia Scale; WHOQOL-Bref, WHO Quality of Life questionnaire.

Figure 2

Pearson’s correlations between clinical data and parameters of sleep quality and quality of life. Numbers within the graph represent Pearson’s R values. Red colour indicates positive correlation, blue negative correlation. BASDI, Bath Ankylosing Spondylitis Disease Activity Index; BDI-II, Beck Depression Inventory II; BMI, body mass index; CRP, C-reactive protein; FFbH, Funktionsfragebogen Hannover questionnaire; Phq-9, Patient health questionnaire 9; QOL, quality of life; RIS Regensburg Insomnia Scale score; WHOQOL-Bref, WHO Quality of Life domain 1 (=physical health-related QOL), D2=mental health-related QOL, D3=social QOL, D4=environmental QOL.

Figure 3

Sex differences in sleep behaviour, and quality of life. Female patients showed significantly more often abnormal sleep behaviour with prolonged sleep latency, disturbed sleep and unrefreshing sleep and had a significantly worse physical and mental health-related quality of life. ***p<0.001; **p<0.01; * <0.05; ns, not significant. HRQOL, health-related quality of life; PI, psychophysiological.