Sleep disorders in rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis

Abstract

Sleep disorders are relatively common among patients with inflammatory arthritis (IA) and have a substantial impact on their quality of life. Although patients frequently recognize poor sleep as an important component of their disease, dyssomnias remain often underdiagnosed and untreated in routine clinical practice. This narrative review examines the prevalence, mechanism, risk factors and management of dyssomnias in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Relevant articles were retrieved from PUBMED, Scopus and DOAJ. The pathomechanism of sleep disorders in IA is multifactorial and partially differs in RA, axSpA and PsA, however, comparative studies are lacking. Various factors affecting sleep quality, including disease activity, pain, mood disorders, fatigue and female gender, have been examined, but their interplay complicates establishing clear causal relationships. The bidirectional link between sleep quality and rheumatic disease activity highlights the complexity of this issue and demonstrates the importance of holistic management of rheumatic patients. Both pharmacological (e.g., hypnotics, NSAIDs, antidepressants, cannabidiol) and non-pharmacological (e.g., psychotherapy, physical activity) interventions for improving sleep were analyzed. Additionally, questionnaires currently used for assessing sleep were discussed. This review aims to provide a comprehensive overview of sleep disorders across the three most common types of IA, emphasizing the need to develop reliable and patient-friendly tools for everyday clinical practice and further comparative research.

Keywords: Arthritis; Axial spondyloarthritis; Dyssomnias; Outcome assessment, Health Care; Patient reported outcome measures; Psoriatic; Quality of life; Rheumatoid; Sleep quality; Sleep wake disorders; Surveys and questionnaires.