Advertisement

Rheumatology International

, Volume 33, Issue 4, pp 1039–1045 | Cite as

Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life

  • İbrahim BatmazEmail author
  • Mustafa Akif Sarıyıldız
  • Banu Dilek
  • Yasin Bez
  • Mehmet Karakoç
  • Remzi Çevik
Original Article

Abstract

The aim of this study is to investigate sleep quality in patients with ankylosing spondylitis (AS) and to evaluate the relationship of the disease parameters with sleep disturbance. Eighty AS patients (60 males and 20 females) fulfilling the modified New York criteria, and 52 age- and gender-matched controls (33 males and 19 females) were enrolled in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Pain was measured by visual analogue scale. The disease activity and functional status were assessed by the Bath AS disease Activity Index and the Bath AS Functional Index. The Bath AS Metrology Index was used to evaluate mobility restrictions, and the Bath AS Radiology Index was employed to evaluate the radiological damage. The psychological status and quality of life were assessed with the hospital anxiety-depression scale and AS quality of life scale. The patients with AS had significantly more unfavourable scores in the subjective sleep quality, habitual sleep efficiency domains (p < 0.001) and the total PSQI score (p < 0.05). Poor sleep quality (total PSQI score) was positively correlated with increased pain, poor quality of life, higher depressed mood, higher disease activity and mobility restrictions. Pain was also an independent contributor to poorer sleep quality (p = 0.002). The sleep quality is disturbed in patients with AS. The lower quality of sleep is greatly associated with the pain, disease activity, depression, quality of life and increased limitation of mobility.

Keywords

Ankylosing spondylitis Disease parameters Psychological state Quality of life Sleep quality 

Notes

Conflict of interest

None.

References

  1. 1.
    Sieper J, Rudwaleit M, Khan MA, Braun J (2006) Concepts and epidemiology of spondyloarthritis. Best Pract Res Clin Rheumatol 20:401–417PubMedCrossRefGoogle Scholar
  2. 2.
    Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A et al (1991) The European Spodyloarthropaty Study Group: preliminary criteria for the classification of spodyloarthropaty. Arthritis Rheum 34:1218PubMedCrossRefGoogle Scholar
  3. 3.
    Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12:247–255PubMedCrossRefGoogle Scholar
  4. 4.
    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 33:1942–1951PubMedGoogle Scholar
  5. 5.
    Hultgren S, Broman JE, Gudbjörnsson B, Hetta J, Lindqvist U (2000) Sleep disturbances in outpatients with ankylosing spondylitis: a questionnaire study with gender implications. Scand J Rheumatol 29:365–369PubMedCrossRefGoogle Scholar
  6. 6.
    Abad VC, Sarinas PSA, Guilleminault G (2008) Sleep and rheumatologic disorders. Sleep Med Rev 12:211–222PubMedCrossRefGoogle Scholar
  7. 7.
    Rudwaleit M, Metter A, Listing J, Sieper J, Braun J (2006) Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 54:569–578PubMedCrossRefGoogle Scholar
  8. 8.
    Drake CL, Roehrs T, Roth T (2003) Insomnia causes, consequences, and therapeutics: an overview. Depression Anxiety 18:163–176CrossRefGoogle Scholar
  9. 9.
    Power JD, Perruccio AV, Badley EM (2005) Pain as a mediator of sleep problems in arthritis and other chronic conditions. Arthritis Care Res 53:911–919CrossRefGoogle Scholar
  10. 10.
    Lindberg E, Janson C, Gislason T, Bjornsson E, Hetta J, Boman G (1997) Sleep disturbances in a young adult population: can gender differences be explained by differences in psychological status? Sleep 20:381–387PubMedGoogle Scholar
  11. 11.
    Maggi S, Langlois JA, Minicuci N, Grigoletto F, Pavan M, Foley DJ (1998) Sleep complaints in community-dwelling older persons: prevalence, associated factors, and reported causes. J Am Geriatr Soc 46:161–168PubMedGoogle Scholar
  12. 12.
    Owens JF, Matthews KA (1998) Sleep disturbances in healthy middle-aged women. Maturitas 30:41–50PubMedCrossRefGoogle Scholar
  13. 13.
    Da Costa D, Zummer M, Fitzcharles MA (2009) Determinants of sleep problems in patients with spondyloarthropathy. Musculoskelet Care 7:143–161CrossRefGoogle Scholar
  14. 14.
    Deodhar A, Braun J, Inman RD, Mack M, Parasurman S, Buchanan J et al (2010) Golimumab reduces sleep disturbance in patients with active ankylosing spondylitis: results from a randomized, placebo-controlled trial. Arhritis Care Res 62:1266–1271CrossRefGoogle Scholar
  15. 15.
    Van der Linden S, Valkenburg H, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 27:361–368PubMedCrossRefGoogle Scholar
  16. 16.
    Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291PubMedGoogle Scholar
  17. 17.
    Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285PubMedGoogle Scholar
  18. 18.
    Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N (2005) A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int 25:280–284PubMedCrossRefGoogle Scholar
  19. 19.
    Yanik B, Gürsel YK, Kutlay S, Ay S, Elhan AH (2005) Adaptation of the Bath Ankylosing Spondylitis Index to the Turkish population, its reliability and validity: functional assessment in AS. Clin Rheumatol 24:41–47PubMedCrossRefGoogle Scholar
  20. 20.
    Jones SD, Porter J, Garrett SL et al (1995) A new scoring system for the Bath Ankylosing Spondylitis Metrology Index (BASMI). J Rheumatol 22:1609PubMedGoogle Scholar
  21. 21.
    Braun J, Golder W, Bollow M, Sieper J, Van der Heijde D (2002) Imaging and scoring in ankylosing spondylitis. Clin Exp Rheumatol 20:178–184Google Scholar
  22. 22.
    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 28:193–213PubMedCrossRefGoogle Scholar
  23. 23.
    Ağargün MY, Kara H, Anlar O (1996) Translation and validation of the Turkish version of the Pittsburg Sleep Quality Index (PSQI). Turk Psikiyatri Dergisi 7(2):107–115Google Scholar
  24. 24.
    Doward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ et al (2003) Development of ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 62:20–26PubMedCrossRefGoogle Scholar
  25. 25.
    Duruöz T, Doward L, Cerrahoglu L, Turan Y, Yurtkuran M, Calis M et al (2007) Validity and reliability of the Turkish version of the ankylosing spondylitis quality of life (ASQoL) scale. In: Proceedings of the 21th congress of national physical medicine and rehabilitation, Antalya, Turkey, p 50Google Scholar
  26. 26.
    Zigmond AS, Snaith PR (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRefGoogle Scholar
  27. 27.
    Aydemir O, Guvenir T, Kuey L, Kultur S (1997) Validity and reability of Turkish version of hospital anxiety and depression scale. Turk Psikiyatri Derg 8:280–287Google Scholar
  28. 28.
    Karadağ Ö, Nakas D, Kalyoncu U, Akdoğan A, Kiraz S, Ertenli İ (2012) Effect of anti-TNF treatment on sleep problems in ankylosing spondylitis. Rheumatol Int 32:1909–1913PubMedCrossRefGoogle Scholar
  29. 29.
    Eddy M, Walbroehl GS (1999) Insomnia. Am Fam Physician 59(7):1911–1916PubMedGoogle Scholar
  30. 30.
    Rajput V, Bromley S (1999) Chronic insomnia: a practical review. Am Fam Physician 60:1431–1438PubMedGoogle Scholar
  31. 31.
    National Heart, Lung, and Blood Institute Working Group on Insomnia (1999) Insomnia: assessment and management in primary care. Am Fam Physician 59:3029–3038Google Scholar
  32. 32.
    Dickens C, McGowan L, Clark-Carter D, Creed F (2002) Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med 64:52–60PubMedGoogle Scholar
  33. 33.
    Sale JE, Gignac M, Hawker G (2008) The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis. J Rheumatol 35:335–342PubMedGoogle Scholar
  34. 34.
    Tsuno N, Besset A, Ritchie K (2005) Sleep and depression. J Clin Psychiatry 66:1254–1269PubMedCrossRefGoogle Scholar
  35. 35.
    Dew MA, Reynolds CF, Monk TH, Buysee DJ, Hoch CC, Jennings HR et al (1994) Psychological correlates and sequelae of EEG sleep in healthy elders. J Gerontol 49:8–18CrossRefGoogle Scholar
  36. 36.
    Sierakowska M, Karpicska A, Sierakowski S, Krajewska-Kuluk E, Kamienska I, Domylawska I (2006) Quality of life of patients with ankylosing spondylitis. Ann Acad Med Stetin 52:29–37PubMedGoogle Scholar
  37. 37.
    Hermann J (2010) Spondyloarthritis and quality of life. Z Rheumatol 69:213–219PubMedCrossRefGoogle Scholar
  38. 38.
    Hakkou J, Rostom S, Aissaoui N, Berrada KR, Abouqal R, Bahiri R et al (2011) Psychological status in Moroccan patients with ankylosing spondylitis and ıts relationships with disease parameters and quality of life. J Clin Rheumatol 17:424–428PubMedCrossRefGoogle Scholar
  39. 39.
    Ozcetin A, Ataoglu S, Kocer E, Yazici S, Yildiz O, Ataoglul A et al (2007) Effects of depression and anxiety on quality of life of patients with rheumatoid arthritis, knee osteoarthritis and fibromyalgia syndrome. West Indian Med J 56:122–129PubMedCrossRefGoogle Scholar
  40. 40.
    Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR (2002) Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 59:131–136PubMedCrossRefGoogle Scholar
  41. 41.
    Manocchia M, Keller S, Ware JE (2011) Sleep problems, health-related quality of life, work functioning and health care utilization among the chronically ill. Qual Life Res 10:331–345CrossRefGoogle Scholar
  42. 42.
    Mengshoel AM, Forre O (1993) Pain and fatigue in patients with rheumatic disorders. Clin Rheumatol 12:515–521PubMedCrossRefGoogle Scholar
  43. 43.
    Jamieson AH, Alford CA, Bird HA, Hindmarch I, Wright V (1995) The effect of sleep and nocturnal movement on stiffness, pain, and psychomotor performance in ankylosing spondylitis. Clin Exp Rheumatol 13:73–78PubMedGoogle Scholar
  44. 44.
    Solak O, Fidan F, Dundar U, Turel A, Aycicek A, Kavuncu V et al (2009) The prevalence of obstructive sleep apnea syndrome in ankylosing spondylitis patients. Rheumatology 48:433–435PubMedCrossRefGoogle Scholar
  45. 45.
    Taylor-Gjevre RM, Gjevre JA, Nair B, Skomro R, Lim HJ (2011) Components of sleep quality and sleep fragmentation in rheumatoid arthritis and osteoarthritis. Musculoskelet Care. doi: 10.1002/msc.208 Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • İbrahim Batmaz
    • 1
    Email author
  • Mustafa Akif Sarıyıldız
    • 1
  • Banu Dilek
    • 1
  • Yasin Bez
    • 2
  • Mehmet Karakoç
    • 1
  • Remzi Çevik
    • 1
  1. 1.Department of Physical Medicine and Rehabilitation, Faculty of MedicineDicle University School of MedicineDiyarbakırTurkey
  2. 2.Department of PsychiatryDicle University School of MedicineDiyarbakırTurkey

Personalised recommendations