Abstract
The aim of this study is to evaluate the relationship between the sleep quality and the disease-related variables, functional status, quality of life, and depressive symptoms in patients with systemic sclerosis (SSc). Forty-eight patients diagnosed with SSc and 42 healthy control subjects were enrolled in the study. The demographic and clinical characteristics of the patients such as the Raynaud’s phenomenon, SSc subtype, digital ulcers, gastrointestinal and lung involvement, and disease activity were recorded. All patients were assessed using the short form 36 (SF-36) quality of life scale, the health assessment questionnaire and the beck depression inventory. Generalized pain and fatigue were assessed with the Visual Analoge Scale. For the evaluation of the sleep disturbance, the SSc and control groups were assessed with the help of the Pittsburgh Sleep Quality Index (PSQI). The patients with SSc had significantly higher scores in the subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance, daytime dysfunction domains, and in terms of the total PSQI score compared to the healthy control group (p < 0.05). According to the results of spearman’s analysis, there was a significantly higher correlation between the generalised pain, fatigue, depressive symptoms, functional status, and physical score of the SF-36 and the sleep disturbance (p < 0.01). There was also a significantly lower correlation between the menopause status, dyspnoea, gastroesophageal reflux, dysphagia, the mental score of the SF-36, and the sleep disturbance (p < 0.05). The sleep quality is disturbed in patients with SSc. The lower quality of sleep is especially associated with the pain, fatigue, depressive symptoms, and functional status.
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Thombs BD, Taillefer SS, Hudson M, Baron M (2007) Depression in patients with systemic sclerosis: a systematic review of the evidence. Arthritis Rheum 57:1089–1097
Bassel M, Hudson M, Taillefer SS, Schieir O, Baron M, Thombs BD (2011) Frequency and impact of symptoms experienced by patients with systemicsclerosis: results from a Canadian National Survey. Rheumatology (Oxford) 50:762–767
Hudson M, Thombs BD, Steele R et al (2009) Health-related quality of life in systemic sclerosis: a systematic review. Arthritis Rheum 61:1112–1120
Malcarne VL, Greenbergs HL (1996) Psychological adjustment to systemic sclerosis. Arthritis Care Res 9:51–59
Van Lankveld WG, Vonk MC, Teunissen H, van den Hoogen FH (2007) Appearance self-esteem in systemic sclerosis subjective experience of skin deformity and its relationship with physician-assessed skin involvement, disease status and psychological variables. Rheumatology 46:872–876
Richards H, Herrick A, Griffin K, Gwilliam P, Fortune D (2004) Psychological adjustment to systemic sclerosis exploring the association of disease factors, functional ability, body related attitudes and fear of negative evaluation. Psychol Health Med 9:29–39
Thombs BD, Bassel M, McGuire L, Smith MT, Hudson M, Haythornthwaite JA (2008) A systematic comparison of fatigue levels in systemic sclerosis with general population, cancer and rheumatic disease samples. Rheumatology 47:1559–1563
Thombs BD, Hudson M, Taillefer SS, Baron M (2008) Canadian Scleroderma Research Group. Prevalence and clinical correlates of symptoms of depression in patients with systemic sclerosis. Arthritis Rheum 59:504–509
Thombs BD, Hudson M, Bassel M, Taillefer SS, Baron M (2009) Canadian Scleroderma Research Group. Sociodemographic, disease, and symptom correlates of fatigue in systemic sclerosis: evidence from a sample of 659 Canadian Scleroderma Research Group registry patients. Arthritis Rheum 61:966–973
Abad VC, Sarinas PS, Guilleminault C (2008) Sleep and rheumatologic disorders. Sleep Med Rev 12:211–228
Matsuura E, Ohta A, Kanegae F et al (2003) Frequency and analysis of factors closely associated with the development of depressive symptoms in patients with scleroderma. J Rheumatol 30:1782–1787
Bodukam V, Hays RD, Maranian P et al (2011) Association of gastrointestinal involvement and depressive symptoms in patients with systemic sclerosis. Rheumatology (Oxford) 50:330–334
Sandusky SB, McGuire L, Smith MT et al (2009) Fatigue: an overlooked determinant of physical function in scleroderma. Rheumatology (Oxford) 48:165–169
Prado GF, Allen RP, Trevisani VM, Toscano VG, Earley CJ (2002) Sleep disruption in systemic sclerosis (scleroderma) patients: clinical and polysomnographic findings. Sleep Med 3:341–345
Milette K, Razykov I, Pope J, Hudson M, Motivala SJ, Baron M, Thombs BD (2011) Clinical correlates of sleep problems in systemic sclerosis: the prominent role of pain. Rheumatology (Oxford) 50:921–925
Frech T, Hays RD, Maranian P, Clements PJ, Furst DE, Khanna D (2011) Prevalence and correlates of sleep disturbance in systemic sclerosis–results from the UCLA scleroderma quality of life study. Rheumatology (Oxford) 50:1280–1287
Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KR et al (2005) Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry 58:175–189
Benrud-Larson LM, Haythornthwaite JA, Heinberg LJ, Boling C, Reed J, White B et al (2002) The impact of pain and symptoms of depression in scleroderma. Pain 95:267–275
Haythornthwaite JA, Heinberg LJ, McGuire L (2003) Psychologic factors in scleroderma [review]. Rheum Dis Clin N Am 29:427–439
Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee (1980) Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 23:581–590
Prevoo ML, van ‘t Hof MA, Kuper HH, van Leeuwen MA, Van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts: development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48
Clements P, Lachenbruch P, Siebold J et al (1995) Inter and intraobserver variability of total skin thickness score (modified Rodnan TSS) in systemic sclerosis. J Rheumatol 22:1281–1285
Valentini G, D’Angelo S, Della Rossa A et al (2003) European Scleroderma Study Group to define disease activity criteria for systemic sclerosis. IV. Assessment of skin thickening by modified Rodnan skin score. Ann Rheum Dis 62:904–905
Ware JE, Sherbourne CD (1992) The MOS 36-item short form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483
Koçyiğit H, Ölmez Ö, Aydemir N, Memiş A (1999) The validity and reliability of Turkish version of the short form 36 (SF- 36). Turkish J Drugs Therap 112:102–106
Kucukdeveci AA, Sahin H, Ataman S, Griffiths B, Tennant A (2004) Issues in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford health assessment questionnaire. Arthritis Rheum 51:14–19
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571
Lasa L, Ayuso-Mateos JL, Vazquez-Barquero JL, Díez-Manrique FJ, Dowrick CF (2000) The use of Beck Depression Inventory to screen for depression in the general population: a preliminary analysis. J Affect Disord 57:261–265
Hisli N (1988) A study on the validity of beck depression inventory. J Psychol 6:118–122
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213
Agargün MY, Kara H, Anlar Ö (1996) Pittsburgh uyku kalitesi indeksi’nin geçerliği ve güvenirliği. Türk Psikiyatri Dergisi 7:107–115
Wolfe F, Michaud K, Li T (2006) Sleep disturbance in patients with rheumatoid arthritis: evaluation by medical outcomes study and visual analog sleep scales. J Rheumatol 33:1942–1951
Drewes AM, Nielsen KD, Hansen B, Taagholt SJ, Bjerregârd K, Svendsen L (2000) A longitudinal study of clinical symptoms and sleep parameters in rheumatoid arthritis. Rheumatology (Oxford) 39:1287–1289
Nicassio PM, Wallston KA (1992) Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis. J Abnorm Psychol 101:514–520
Nicassio PM, Ormseth SR, Kay M, Custodio M, Irwin MR, Olmstead R, Weisman MH (2012) The contribution of pain and depression to self reported sleep disturbance in patients with rheumatoid arthritis. Pain 153:107–112
Cakirbay H, Bilici M, Kavakci O, Cebi A, Güler M, Tan U (2004) Sleep quality and immune functions in rheumatoid arthritis patients with and without major depression. Int J Neurosci 114:245–256
Medsger TA Jr (1996) Systemic sclerosis (scleroderma): clinical aspects. In: Koopman WJ (ed) Arthritis and allied conditions. A textbook of rheumatology, 13th edn. Williams and Wilkins, Baltimore, pp 1433–1464
Castiglione F, Emde C, Armstrong D, Schneider C, Bauerfeind P, Stacher G, Blum AL (1993) Nocturnal oesophageal motor activity is dependent on sleep stage. Gut 34:1653–1659
Bodukam V, Hays RD, Maranian P et al (2011) Association of gastrointestinal involvement and depressive symptoms in patients with systemic sclerosis. Rheumatology 50:330–334
Luyster FS, Chasens ER, Wasko MC, Dunbar-Jacob J (2011) Sleep quality and functional disability in patients with rheumatoid arthritis. J Clin Sleep Med 7:49–55
Kronenberg F, Cote LJ, Linkie DM, Dyrenfurth I, Downey JA (1984) Menopausal hot flashes: thermoregulatory, cardiovascular, and circulating catecholamine and LH changes. Maturitas 6:31–43
Cignarelli M, Cicinelli E, Corso M, Cospite MR, Garruti G, Tafaro E, Giorgino R, Schonauer S (1989) Biophysical and endocrine metabolic changes during menopausal hot flashes: increase in plasma free fatty acid and norepinephrine levels. Gynecol Obstet Investig 27:34–37
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Sariyildiz, M.A., Batmaz, I., Budulgan, M. et al. Sleep quality in patients with systemic sclerosis: relationship between the clinical variables, depressive symptoms, functional status, and the quality of life. Rheumatol Int 33, 1973–1979 (2013). https://doi.org/10.1007/s00296-013-2680-9
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DOI: https://doi.org/10.1007/s00296-013-2680-9