Skip to main content

Advertisement

SpringerLink
Log in

The evaluation of sleep quality and response to anti-tumor necrosis factor α therapy in rheumatoid arthritis patients

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Poor sleep quality (SQ) is increasingly recognized as giving rise to decreased quality of life, and raising pain perception. Our aim is to evaluate the SQ in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor alpha (anti-TNF-α) therapy. This was a prospective observational and open-label study of RA patients. A total of 35 patients with RA were enrolled in this study. Of the 35 patients, 22 had high disease activity (DA), and 13 were in remission. High DA group was initiated an anti TNF-α therapy. Clinical and objective parameters of SQ were assessed by using the Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG). The total PSQI score and the frequency of poor SQ were high in 60 % of the RA patients. The median PSQI score was significantly higher in the high DA group than in the remission group (P = 0.026). Following an anti-TNF-α therapy initiation, significant improvements were observed in the high DA group by PSQI test (P = 0.012). However, no statistically significant difference was found by PSG (P > 0.05). Although an improvement in DA with anti-TNF-alpha therapy did not provide an amelioration in laboratory parameters, we found a significant improvement in SQ by subjective PSQI test. These findings may support that sleep disorders in RA are likely to be associated with a complex pathophysiology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Albani S, Carson D (1997) Etiology and pathogenesis of rheumatoid arthritis. Arthritis and allied conditions. Lippincott Williams & Wilkins, Baltimore MD, p. 979

    Google Scholar 

  2. McInnes IB, Schett G (2011) The pathogenesis of rheumatoid arthritis. N Engl J Med 365(23):2205–2219

    Article  CAS  PubMed  Google Scholar 

  3. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 8(5):597–619

    PubMed  PubMed Central  Google Scholar 

  4. Opp M, Kapas L, Toth L (1992) Cytokine involvement in the regulation of sleep. Experimental Biology and Medicine 201(1):16–27

    Article  CAS  Google Scholar 

  5. Vgontzas AN, Papanicolaou DA, Bixler EO, Lotsikas A, Zachman K, Kales A, et al. (1999) Circadian interleukin-6 secretion and quantity and depth of sleep. The Journal of Clinical Endocrinology & Metabolism 84(8):2603–2607

    Article  CAS  Google Scholar 

  6. Mastorakos G, Chrousos GP, Weber JS (1993) Recombinant interleukin-6 activates the hypothalamic-pituitary-adrenal axis in humans. The Journal of Clinical Endocrinology & Metabolism 77(6):1690–1694

    CAS  Google Scholar 

  7. Isomäki P, Punnonen J (1997) Pro- and anti-inflammatory cytokines in rheumatoid arthritis. Ann Med 29(6):499–507

    Article  PubMed  Google Scholar 

  8. Drewes A (1999) Pain and sleep disturbances with special reference to fibromyalgia and rheumatoid arthritis. Rheumatology 38(11):1035–1038

    Article  CAS  PubMed  Google Scholar 

  9. Moldofsky H, Lue F, Smythe H (1983) Alpha EEG sleep and morning symptoms in rheumatoid arthritis. J Rheumatol 10(3):373–379

    CAS  PubMed  Google Scholar 

  10. Gjevre JA, Taylor-Gjevre RM, Nair BV, Lim HJ (2012) Do sleepy rheumatoid arthritis patients have a sleep disorder? Musculoskeletal Care 10(4):187–195

    Article  PubMed  Google Scholar 

  11. Zamarron C, Maceiras F, Mera A, Gomez-Reino J (2004) Effect of the first infliximab infusion on sleep and alertness in patients with active rheumatoid arthritis. Ann Rheum Dis 63(1):88–90

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Desai SB, Furst DE (2006) Problems encountered during anti-tumour necrosis factor therapy. Best Practice & Research Clinical Rheumatology 20(4):757–790

    Article  CAS  Google Scholar 

  13. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European league against rheumatism collaborative initiative. Arthritis & Rheumatism 62(9):2569–2581

    Article  Google Scholar 

  14. Wells G, Becker J, Teng J, Dougados M, Schiff M, Smolen J, et al. (2009) Validation of the 28-joint disease activity score (DAS28) and European league against rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis 68(6):954–960

    Article  CAS  PubMed  Google Scholar 

  15. Prevoo M, Van’t Hof M, Kuper H, Van Leeuwen M, Van de Putte L, Van Riel P (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 & Rheumatism 38(1):44–48

    Article  CAS  Google Scholar 

  16. Pinals RS, Masi AT, Larsen RA (1981) Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis & Rheumatism 24(10):1308–1315

    Article  CAS  Google Scholar 

  17. Van Gestel A, Prevoo M, Van’t Hof M, Van Rijswijk M, Van de Putte L, Van Riel P (1996) Development and validation of the European league against rheumatism response criteria for rheumatoid arthritis: comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism criteria. Arthritis & Rheumatism 39(1):34–40

    Article  CAS  Google Scholar 

  18. Fries JF, Spitz P, Kraines RG, Holman HR (1980) Measurement of patient outcome in arthritis. Arthritis & Rheumatism 23(2):137–145

    Article  CAS  Google Scholar 

  19. 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(2):193–213

    Article  CAS  PubMed  Google Scholar 

  20. Agargun MY, Kara H, Anlar O (1996) Pittsburgh uyku kalitesi indeksinin geçerliliği ve güvenilirliği. Türk Psikiyatri Dergisi

  21. Ohayon MM, Roth T (2002) Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res 53(1):547–554

    Article  PubMed  Google Scholar 

  22. Bekci TT, Kayrak M, Kiyici A, Ari H, Teke T, Maden E, et al. (2012) The relation between Lp-PLA2 levels with periodic limb movements. Sleep and Breathing 16(1):117–122

    Article  PubMed  Google Scholar 

  23. Laureys S, Tononi G (2011) The neurology of consciousness: cognitive neuroscience and neuropathology: Academic Press

  24. Spriggs WH (2014) Essentials of polysomnography: Jones & Bartlett Publishers

  25. Solak Ö, Dündar Ü, Demirdal ÜS, Fidan F, Gökçe Ġ, Ünlü M (2009) Romatoid artrit hastalarının pittsburgh uyku kalite indeksi ile değerlendirilmesi. Türk Fiz Tıp Rehab Derg 55:107–101

    Google Scholar 

  26. Løppenthin K, Esbensen B, Jennum P, Østergaard M, Tolver A, Thomsen T, et al (2015) Sleep quality and correlates of poor sleep in patients with rheumatoid arthritis. Clinical rheumatology. 1–11.

  27. Sariyildiz MA, Batmaz I, Bozkurt M, Bez Y, Cetincakmak MG, Yazmalar L, et al. (2014) Sleep quality in rheumatoid arthritis: relationship between the disease severity, depression, functional status and the quality of life. Journal of clinical medicine research 6(1):44

    PubMed  Google Scholar 

  28. Luyster FS, Chasens ER, Wasko MCM, Dunbar-Jacob J (2011) Sleep quality and functional disability in patients with rheumatoid arthritis. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 7(1):49

    Google Scholar 

  29. Wells G, Li T, Tugwell P (2010) Investigation into the impact of abatacept on sleep quality in patients with rheumatoid arthritis, and the validity of the MOS-sleep questionnaire sleep disturbance scale. Ann Rheum Dis 69(10):1768–1773

    Article  PubMed  Google Scholar 

  30. Drewes AM, Svendsen L, Taagholt SJ, Bjerregård K, Nielsen KD, Hansen B (1998) Sleep in rheumatoid arthritis: a comparison with healthy subjects and studies of sleep/wake interactions. Rheumatology 37(1):71–81

    Article  CAS  Google Scholar 

  31. Mahowald MW, Mahowald ML, Bundlie SR, Ytterberg SR (1989) Sleep fragmentation in rheumatoid arthritis. Arthritis & Rheumatism 32(8):974–983

    Article  CAS  Google Scholar 

  32. Vgontzas A, Zoumakis E, Lin H-M, Bixler E, Trakada G, Chrousos G (2004) Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-α antagonist. The Journal of Clinical Endocrinology & Metabolism 89(9):4409–4413

    Article  CAS  Google Scholar 

  33. Abad VC, Sarinas PS, Guilleminault C. Sleep and rheumatologic disorders. Sleep Med Rev. 2008;12(3):211–28.

  34. Taylor-Gjevre RM, Gjevre JA, Skomro RP, Nair BV, Lim HJ (2011) Improved sleep efficiency after anti-tumor necrosis factor α therapy in rheumatoid arthritis patients. Therapeutic advances in musculoskeletal disease 3(5):227–233

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Zamarrón C, Maceiras F, González J, Gómez-Reino JJ (2004) Worsening of obstructive sleep apnoeas in a patient with rheumatoid arthritis treated with anti-tumor necrosis factor. Respir Med 98(2):123–125

    Article  PubMed  Google Scholar 

  36. Coito AL, Belo D, Paiva T, Sanches JM, editors (2011) Topographic EEG brain mapping before, during and after obstructive sleep apnea episodes. Biomedical imaging: from nano to macro, 2011 I.E. International Symposium on; IEEE

  37. Shoda N, Seichi A, Takeshita K, Chikuda H, Ono T, Oka H, et al. (2009) Sleep apnea in rheumatoid arthritis patients with occipitocervical lesions: the prevalence and associated radiographic features. Eur Spine J 18(6):905–910

    Article  PubMed  PubMed Central  Google Scholar 

  38. Berger K, Luedemann J, Trenkwalder C, John U, Kessler C (2004) Sex and the risk of restless legs syndrome in the general population. Arch Intern Med 164(2):196–202

    Article  PubMed  Google Scholar 

  39. Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C (2000) Epidemiology of restless legs symptoms in adults. Arch Intern Med 160(14):2137–2141

    Article  CAS  PubMed  Google Scholar 

  40. Wollina U, Ständer K, Barta U (2001) Toxicity of methotrexate treatment in psoriasis and psoriatic arthritis–short-and long-term toxicity in 104 patients. Clin Rheumatol 20(6):406–410

    Article  CAS  PubMed  Google Scholar 

  41. Murphy PJ, Badia P, Myers BL, Boecker MR, Wright KP. Nonsteroidal anti-inflammatory drugs affect normal sleep patterns in humans. Physiol Behav. 1994;55(6):1063–6.

Download references

Author information

Authors and Affiliations

  1. Department of Physical Medicine, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, 06100, Altindag, Ankara, Turkey

    Gulsah Karatas & Elif Yalcin

  2. Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

    Ajda Bal, Deniz Dulgeroglu & Aytul Cakci

  3. Department of Respiratory and Sleep Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

    Melike Yuceege, Hikmet Firat & Sadik Ardic

  4. Department of Internal Medicine and Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

    Fatih Karataş & Suleyman Sahin

Authors
  1. Gulsah Karatas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ajda Bal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melike Yuceege
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elif Yalcin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hikmet Firat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Deniz Dulgeroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fatih Karataş
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Suleyman Sahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Aytul Cakci
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sadik Ardic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gulsah Karatas.

Ethics declarations

Disclosures

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karatas, G., Bal, A., Yuceege, M. et al. The evaluation of sleep quality and response to anti-tumor necrosis factor α therapy in rheumatoid arthritis patients. Clin Rheumatol 36, 45–50 (2017). https://doi.org/10.1007/s10067-016-3387-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-016-3387-6

Keywords

Search

Navigation