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Sleep disturbance in Moroccan patients with ankylosing spondylitis: Prevalence and relationships with disease-specific variables, psychological status and quality of life

Abstract

Sleep disturbance is often reported by the patients with ankylosing spondylitis (AS), with awakenings produced by inflammatory pain. There are limited studies about sleep disturbance on these patients, and especially its association with psychological state and quality of life to examine the prevalence of sleep disturbance and to assess its association with disease-specific variables, psychological status and quality of life. One hundred and ten patients were included in this cross-sectional study according to the modified New York criteria for AS. Clinical and biological parameters were evaluated. Sleep disturbance was assessed by the fourth item of Hamilton Anxiety Scale. Psychological status was assessed by The Hospital Anxiety and Depression Scale including depression subscale and anxiety subscale. The quality of life was evaluated by the short form-36 (SF-36). Sleep disturbance was found in 64.5 %, depression in 55.5 % and anxiety in 60.9 % amongst our patients. Significantly, worse pain, higher disease activity and functional disability were present in patients with sleep disturbance. Likewise, sleep problems were significantly higher in patients with depression, anxiety and in patients with low scores of the SF36. Multivariate logistic regression analysis revealed that the pain (OR = 1.019) and depression (OR = 1.304) were independent risk factors that influenced sleep disturbance. Sleep problems are prevalent amongst Moroccan patients with AS. Our findings suggest that pain and depression were the independent risk factors that influenced the sleep disturbance and hence, the need for evaluation and optimal management of pain and depression to improve sleep quality in AS patients.

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References

  1. 1.

    Calin A (1998) Ankylosing spondylitis. In: Maddison PJ, Isenberg D, Woo P, Glass D (eds) Oxford textbook of rheumatology, 2nd edn. Oxford Medical Publications, Oxford University Press, USA, pp 1058–1060

    Google Scholar 

  2. 2.

    Pham T (2008) Pathophysiology of ankylosing spondylitis: what’s new? Joint Bone Spine 75:656–660

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Lee YC, Chibnik LB, Lu B et al (2009) The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study. Arthr Res Ther 11:R160. doi:10.1186/ar2842

    Article  Google Scholar 

  4. 4.

    Frech T, Hays RD, Maranian P et al (2011) Prevalence and correlates of sleep disturbance in systemic sclerosis–results from the UCLA scleroderma quality of life study. Rheumatology (Oxford) 50:1280–1287

    Article  Google Scholar 

  5. 5.

    Buskila D, Cohen H (2007) Comorbidity of fibromyalgia and psychiatric disorders. Curr Pain Headache Rep 11:333–338

    PubMed  Article  Google Scholar 

  6. 6.

    Jones SD, Koh WH, Steiner A et al (1996) Fatigue in ankylosing spondylitis: its prevalence and relationship to disease activity, sleep, and other factors. J Rheumatol 23:487–490

    PubMed  CAS  Google Scholar 

  7. 7.

    Van Tubergen A, Coenen J, Landewe R et al (2002) Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis. Arthritis Rheum 47:8–16

    PubMed  Article  Google Scholar 

  8. 8.

    Obal F Jr, Opp M, Cady AB et al (1990) Interleukin 1 alpha and an interleukin 1 beta fragment are somnogenic. Am J Physiol 259:439–446

    Google Scholar 

  9. 9.

    Moldofsky H, Lue FA, Eisen J et al (1986) The relationship of interleukin-1 and immune functions to sleep in humans. Psychosom Med 48:309–318

    PubMed  CAS  Google Scholar 

  10. 10.

    Reichlin S (1993) Neuroendocrine-immune interactions. N Engl J Med 21:1246–1253

    Google Scholar 

  11. 11.

    Baysal Ö, Durmuş B, Ersoy Y et al (2011) Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis. Rheumatol Int 31:795–800

    PubMed  Article  Google Scholar 

  12. 12.

    Ibn Yacoub Y, Amine B, Laatiris A et al (2011) Health-related quality of life in Moroccan patients with ankylosing spondylitis. Clin Rheumatol 30:673–677

    PubMed  Article  Google Scholar 

  13. 13.

    Van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    PubMed  Article  Google Scholar 

  14. 14.

    Garrett S, Jenkinson T, Kennedy LG et al (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). J Rheumatol 21:2286–2291

    PubMed  CAS  Google Scholar 

  15. 15.

    Rostom S, Benbouazza K, Amine B et al (2010) Psychometric evaluation of the Moroccan version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for use in patients with ankylosing spondylitis. Clin Rheumatol 29(7):781–788

    PubMed  Article  Google Scholar 

  16. 16.

    Calin A, Garrett S, Whitelock H et al (1994) New approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index (BASFI). J Rheumatol 21:2281–2285

    PubMed  CAS  Google Scholar 

  17. 17.

    Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Malasi TH, Mirza IA, el-Islam MF (1991) Validation of the Hospital Anxiety and Depression Scale in Arab patients. Acta Psychiatr Scand 84:323–326

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Michopoulos I, Douzenis A, Kalkavoura C et al (2008) Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample. Ann Gen Psychiatry 7:4

    PubMed  Article  Google Scholar 

  21. 21.

    Olssøn I, Mykletun A, Dahl AA (2005) The hospital anxiety and depression rating scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry 5:46

    PubMed  Article  Google Scholar 

  22. 22.

    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

    PubMed  Article  Google Scholar 

  23. 23.

    Ware J, Kosinski M, Bayliss M et al (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 33:AS264–AS279

    PubMed  Article  Google Scholar 

  24. 24.

    Khoudri I, Ali Zeggwagh A, Abidi K et al (2007) Measurement properties of the short form 36 and health-related quality of life after intensive care in Morocco. Acta Anaesthesiol Scand 51(2):189–197

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12:247–255

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Günaydin R, Göksel Karatepe A, Ceşmeli N et al (2009) Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance. Clin Rheumatol 28(9):1045–1051

    PubMed  Article  Google Scholar 

  27. 27.

    Da Costa D, Zummer M, Fitzcharles MA (2009) Determinants of sleep problems in patients with spondyloarthropathy. Musculoskeletal Care 7(3):143–161

    PubMed  Article  Google Scholar 

  28. 28.

    Heiberg T, Lie E, van der Heijde D et al (2010) Sleep problems are of higher priority for improvement for patients with ankylosing spondylitis than for patients with other inflammatory arthropathies. Ann Rheum Dis 70(5):872–873

    PubMed  Article  Google Scholar 

  29. 29.

    Goldenberg DL (1995) Fatigue in rheumatic disease. Bull Rheum Dis 44(1):4–8

    PubMed  CAS  Google Scholar 

  30. 30.

    Wolfe F, Hawley DJ, Wilson K (1996) The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol 23(8):1407–1417

    PubMed  CAS  Google Scholar 

  31. 31.

    Taylor-Gjevre RM, Gjevre JA, Nair B et al (2010) Hypersomnolence and sleep disorders in a rheumatic disease patient population. J Clin Rheumatol 16(6):255–261

    PubMed  Article  Google Scholar 

  32. 32.

    Mease PJ, Arnold LM, Crofford LJ, Williams DA (2008) Identifying the clinical domains of fibromyalgia: contributions from clinician and patient Delphi exercises. Arthritis Rheum 59(7):952–960

    PubMed  Article  Google Scholar 

  33. 33.

    Bigatti SM, Hernandez AM, Cronan TA et al (2008) Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum 59(7):961–967

    PubMed  Article  Google Scholar 

  34. 34.

    Theadom A, Cropley M, Humphrey KL (2007) Exploring the role of sleep and coping in quality of life in fibromyalgia. J Psychosom Res 62(2):145–151

    PubMed  Article  Google Scholar 

  35. 35.

    Nicassio P, Wallston K (1992) Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis. J Abnorm Psychol 101(3):514–520

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Chandrasekhara PK, Jayachandran NV, Rajasekhar L et al (2009) The prevalence and associations of sleep disturbances in patients with systemic lupus erythematosus. Mod Rheumatol 19(4):407–415

    PubMed  Article  Google Scholar 

  37. 37.

    Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12:247–255

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Barlow JH, Macey SJ, Struthers GR (1993) Gender, depression, and ankylosing spondylitis. Arthritis Care Res 6(1):45–51

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Rugienne R, Kirdaite G, Grazuleviciute E et al (2008) The quality of life and functional ability in patients with ankylosing spondylitis. Acta Med Lituanica 15(2):99–103

    Google Scholar 

  40. 40.

    Dealberto MJ (1992) Sleep disorders in psychiatric diseases. Epidemiological aspects. Encephale 18(4):331–340

    PubMed  CAS  Google Scholar 

  41. 41.

    Atkinson JH, Ancoli-israel S, Slater MA et al (1988) Subjective sleep disturbance in chronic back pain. Clin J Pain 4:225–232

    Article  Google Scholar 

  42. 42.

    Pilowsky I, Crettenden I, Townley M (1985) Sleep disturbance in pain clinic patients. Pain 23:27–33

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Moffitt PF, Kalucy EC, Kalucy RS et al (1991) Sleep difficulties, pain and other correlates. J Intern Med 230:245–249

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Jinane Hakkou.

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Hakkou, J., Rostom, S., Mengat, M. et al. Sleep disturbance in Moroccan patients with ankylosing spondylitis: Prevalence and relationships with disease-specific variables, psychological status and quality of life. Rheumatol Int 33, 285–290 (2013). https://doi.org/10.1007/s00296-012-2376-6

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Keywords

  • Sleep disturbance
  • Ankylosing spondylitis
  • Quality of life
  • Depression
  • Anxiety