Sleep in ankylosing spondylitis and non-radiographic axial spondyloarthritis: associations with disease activity, gender and mood
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The study aims were to assess the prevalence of good or poor sleep in a cohort of axial spondyloarthritis patients and to investigate its correlation with a range of objectively and subjectively measured variables in order to develop a model for distinguishing good from poor sleepers. Five hundred ninety-eight patients with ankylosing spondylitis and 61 with non-radiographic axial spondyloarthritis completed the Jenkins Sleep Evaluation Questionnaire. Measures of disease activity, mobility, function, mood, fatigue, quality of life, work productivity, night-time pain and general health were gathered. Patients with ankylosing spondylitis or non-radiographic axial spondyloarthritis were initially compared. With the exception of waking up tired less often and having lower mobility and functioning, the two groups were similar so were combined for subsequent analysis. Twenty-nine percent of all patients were classified as good sleepers and 19% as poor sleepers. Poor sleepers had higher disease activity and fatigue scores and more night-time back pain than good sleepers. They reported poorer quality of life, general health, mood and work-related measures. A model incorporating mood, gender, fatigue and objective and subjective judgements of disease activity correctly classified 87.3% of good and poor sleepers. Poor sleep was strongly associated with poor mood, female gender, greater fatigue, greater disease activity (specifically, spinal pain and stiffness) and better mobility; however, the direction of causality between poor sleep and markers of active disease was undetermined. This study also highlights the need to standardise the measurement of sleep disturbance in axSpA to facilitate comparisons between patient groups and interventions.
KeywordsAnkylosing spondylitis Fatigue Gender Quality of life Sleep
AW is the main author of this paper and is responsible for data analysis. EC and SL reviewed and edited the manuscript. RS provided access to the data and reviewed and edited the manuscript.
Compliance with ethical standards
Bristol UK local research ethics committee (LREC) for National Health Service research approved the study, and all patients provided informed, written consent (the Bath Spondyloarthritis (SpA) Biobank; REC reference: 13/SW/0096).
Consent for publication
- 1.Heiberg T, Lie E, van Der Heijde D, Kvien TK (2011) 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. https://doi.org/10.1136/ard.2010.133793 CrossRefPubMedGoogle Scholar
- 2.Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12(4):247–255. https://doi.org/10.1002/1529-0131(199908)12:4<247::AID-ART3>3.0.CO;2-H CrossRefPubMedGoogle Scholar
- 6.Batmaz I, Sariyildiz M, Dilek B, Bez Y, Karakoc M, Cevik R (2013) Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatol Int 33(4):1039–1045. https://doi.org/10.1007/s00296-012-2513-2 CrossRefPubMedGoogle Scholar
- 9.Jiang Y, Yang M, Wu H, Song H, Zhan F, Liu S, Gao G, Liu Z, Hu Z, He P, Zhang S, Hu Z, Lin Z, Zhang Y, Li Y, Shen L, Huang A, Liao Z, Cao S, Wei Y, Li L, Li Q, Lv Q, Qi J, Huang J, Li T, Jin O, Pan Y, Gu J (2015) The relationship between disease activity measured by the BASDAI and psychological status, stressful life events, and sleep quality in ankylosing spondylitis. Clin Rheumatol 34(3):503–510. https://doi.org/10.1007/s10067-014-2688-x CrossRefPubMedGoogle Scholar
- 11.Spitzer KL, Hays RD. MOS sleep scale: a manual for use and scoring, version 1.0. Los Angeles, CA, RAND, 2003Google Scholar
- 13.Hetta J, Almqvist M, Ågren H, Hambert G, Liljenberg B, Roos B-E (1985) Prevalence of sleep disturbances and related symptoms in a middle-aged Swedish population. In: Koella WP, Ruther E, Schulz H (eds) Sleep '84. Gustav Fischer Verlag, Stuttgart, pp 373–376Google Scholar
- 16.Kinnucan JA, Rubin DT, Ali T (2013) Sleep and inflammatory bowel disease: exploring the relationship between sleep disturbances and inflammation. Gastroenterol Hepatol (NY) 9:718–727Google Scholar
- 18.Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV (2004) Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 27(7):1255–1273. https://doi.org/10.1093/sleep/27.7.1255 CrossRefPubMedGoogle Scholar
- 21.Deodhar A, Braun J, Inman R, Mack M, Parasuraman S, Buchanan J et al (2010) Golimumab reduces sleep disturbance in patients with active ankylosing spondylitis: results from a randomized, placebo-controlled trial. Arthritis Care Res 62(9):1266–1271. https://doi.org/10.1002/acr.20233 CrossRefGoogle Scholar
- 22.Bao C, Huang F, Khan M, Fei K, Wu Z, Zhuang Y et al (2014) Safety and efficacy of golimumab in Chinese patients with active ankylosing spondylitis: 1-year results of a multicentre, randomized, double-blind, placebo-controlled phase III trial. Rheumatology 53(9):1654–1663. https://doi.org/10.1093/rheumatology/keu132 CrossRefPubMedGoogle Scholar
- 27.Webster K, Cella D, Yost K (2003) The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcomes 16:1–79Google Scholar
- 28.Reynolds S, Doward LC, Spoorenberg A, Helliwell PS, McKenna SP, Tennant L, et al. The development of the ankylosing spondylitis quality of life questionnaire (ASQoL). Qual Life Res 1999;8:651Google Scholar
- 31.Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale. NJGoogle Scholar
- 33.Wadeley A. Cognitive correlates of sleepiness and fatigue in sleep-disrupted mothers of children aged under five years. In: British Psychological Society Annual Conference, 7–9 2014, International Convention Centre, Birmingham, UKGoogle Scholar