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

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.

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References

  1. 1.

    Sieper J, Rudwaleit M, Khan MA, Braun J (2006) Concepts and epidemiology of spondyloarthritis. Best Pract Res Clin Rheumatol 20:401–417

    PubMed  Article  Google 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 34:1218

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    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 

  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 33:1942–1951

    PubMed  Google 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 29:365–369

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Abad VC, Sarinas PSA, Guilleminault G (2008) Sleep and rheumatologic disorders. Sleep Med Rev 12:211–222

    PubMed  Article  Google 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 54:569–578

    PubMed  Article  Google Scholar 

  8. 8.

    Drake CL, Roehrs T, Roth T (2003) Insomnia causes, consequences, and therapeutics: an overview. Depression Anxiety 18:163–176

    Article  Google 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 53:911–919

    Article  Google 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 20:381–387

    PubMed  CAS  Google 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 46:161–168

    PubMed  CAS  Google Scholar 

  12. 12.

    Owens JF, Matthews KA (1998) Sleep disturbances in healthy middle-aged women. Maturitas 30:41–50

    PubMed  Article  CAS  Google Scholar 

  13. 13.

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

    Article  Google 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 62:1266–1271

    Article  Google 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 27:361–368

    PubMed  Article  Google 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 21:2286–2291

    PubMed  CAS  Google 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 21:2281–2285

    PubMed  CAS  Google 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 25:280–284

    PubMed  Article  Google 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 24:41–47

    PubMed  Article  Google 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 22:1609

    PubMed  CAS  Google 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 20:178–184

    Google 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 28:193–213

    PubMed  Article  CAS  Google 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):107–115

    Google 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 62:20–26

    PubMed  Article  CAS  Google 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 50

  26. 26.

    Zigmond AS, Snaith PR (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    PubMed  Article  CAS  Google 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 8:280–287

    Google 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 32:1909–1913

    PubMed  Article  Google Scholar 

  29. 29.

    Eddy M, Walbroehl GS (1999) Insomnia. Am Fam Physician 59(7):1911–1916

    PubMed  CAS  Google Scholar 

  30. 30.

    Rajput V, Bromley S (1999) Chronic insomnia: a practical review. Am Fam Physician 60:1431–1438

    PubMed  CAS  Google Scholar 

  31. 31.

    National Heart, Lung, and Blood Institute Working Group on Insomnia (1999) Insomnia: assessment and management in primary care. Am Fam Physician 59:3029–3038

    Google 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 64:52–60

    PubMed  Google 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 35:335–342

    PubMed  Google Scholar 

  34. 34.

    Tsuno N, Besset A, Ritchie K (2005) Sleep and depression. J Clin Psychiatry 66:1254–1269

    PubMed  Article  Google 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 49:8–18

    Article  Google 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 52:29–37

    PubMed  Google Scholar 

  37. 37.

    Hermann J (2010) Spondyloarthritis and quality of life. Z Rheumatol 69:213–219

    PubMed  Article  CAS  Google 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 17:424–428

    PubMed  Article  Google 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 56:122–129

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR (2002) Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 59:131–136

    PubMed  Article  Google 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 10:331–345

    Article  Google Scholar 

  42. 42.

    Mengshoel AM, Forre O (1993) Pain and fatigue in patients with rheumatic disorders. Clin Rheumatol 12:515–521

    PubMed  Article  CAS  Google 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 13:73–78

    PubMed  CAS  Google 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 48:433–435

    PubMed  Article  Google 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 

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Correspondence to İbrahim Batmaz.

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Batmaz, İ., Sarıyıldız, M.A., Dilek, B. et al. Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatol Int 33, 1039–1045 (2013). https://doi.org/10.1007/s00296-012-2513-2

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Keywords

  • Ankylosing spondylitis
  • Disease parameters
  • Psychological state
  • Quality of life
  • Sleep quality