AxSpA and Insomnia: Is There a Link?

Almost half of patients with spondyloarthritis showed symptoms of insomnia despite treatment in accordance with disease management guidelines, according to a study published online in RMD Open.

“Furthermore, we observed a higher rate of women with sleep disturbances, with sex differences especially pronounced regarding severe insomnia,” wrote corresponding author Natalie Frede, MD, and coauthors from the University of Freiburg, in Freiburg, Germany,

The study included 330 patients with spondyloarthritis from the outpatient rheumatology clinic at the University Medical Center Freiburg. Among patients, 168 had psoriatic arthritis (PsA) and 162 had axial spondyloarthritis (axSpA). Researchers conducted a retrospective chart analysis and also surveyed patients about sleep quality, quality of life, functional impairment, and depressive symptoms. Patients with axSpA were treated according to 2016 recommendations from the Assessment of SpondyloArthritis International Society and European Alliance of Associations for Rheumatology. Patients with PsA were treated according to 2015 recommendations from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.

According to the study, 46.6% of patients with spondyloarthritis had abnormal sleep behavior as indicated by scores of 13 or higher on the Regensburg Insomnia Scale. In patients with axSpA, human leukocyte antigen B27 positivity, disease activity per the Bath Ankylosing Spondylitis Disease Activity Index, depressive symptoms, functional capacity, and disease duration predicted insomnia symptoms. In patients with PsA, depressive symptoms, female sex, and Disease Activity Score in 28 Joints predicted insomnia symptoms.

The study also found associations between unrestful sleep and decreased health-related quality of life and increased depressive symptoms. Patients with unrestful sleep also rated their health satisfaction lower.

Women reported significantly worse sleep than men, researchers noted. Women often needed more time to fall asleep, were not able to sleep through the night, and did not feel refreshed in the morning. Women also reported a poorer physical and mental health-related quality of life and more depressive symptoms.

“Awareness of risk factors and sex differences will help to identify patients, who may benefit from additional interventions, such as patient education, exercise, or light therapy, or cognitive behavioral therapy techniques,” researchers wrote, “and, thus, improve patient-centric outcomes.”

Reference
Frede N, Rieger E, Lorenzetti R, et al. Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms. RMD Open. 2023;9(2):e002912. doi:10.1136/rmdopen-2022-002912