Sleep Matters: Exploring the Link Between Sleep Disturbances and Fatigue in Rheumatoid Arthritis

Abstract

Objective: Fatigue is a prevalent and debilitating symptom for patients with rheumatoid arthritis (RA). Although patients and rheumatologists often attribute fatigue to inflammation, other factors such as sleep disturbances are frequently overlooked. This study aims to explore the relationship between subjective (self-reported) and objective (actigraphy based) sleep parameters and self-reported fatigue in patients with RA.

Methods: This cross-sectional analysis included data from 48 adult patients with RA from a single academic rheumatology practice. Sleep data were obtained daily over 14 days with actigraphy (objective) and the Karolinska Sleep Diary (subjective). Fatigue was assessed using the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue computerized adaptive test. Spearman's correlations and linear regression analyses were used to examine associations between sleep parameters and fatigue, adjusting for swollen joint count, pain intensity, and symptoms of depression.

Results: Subjective sleep parameters showed significant correlations with PROMIS fatigue. Longer total sleep time (ρ = -0.4, P < 0.01), higher sleep efficiency (ρ = -0.42, P < 0.01), and better sleep quality (ρ = -0.5, P < 0.01) were associated with lower levels of fatigue. Objective actigraphy-based sleep parameters were not significantly associated with PROMIS fatigue. Separate linear regression models demonstrated that each subjective sleep parameter remained significantly associated with fatigue after adjusting for covariates.

Conclusion: Self-reported poor sleep duration, efficiency, and quality were significantly associated with fatigue in patients with RA, whereas objective actigraphy-based sleep parameters were not, supporting the integration of self-reported assessment of sleep disturbances into RA treatment plans to improve patient outcomes.

Figure 1

Scatter plots illustrating the relationship between self‐reported sleep parameters and PROMIS fatigue. Each plot shows the correlation between PROMIS fatigue and (A) WASO, (B) sleep efficiency, (C) sleep quality index, and (D) sleep duration, based on Spearman's correlation coefficients. PROMIS, Patient‐Reported Outcome Measurement Information System; WASO, wake after sleep onset.