Sleep Quality in Systemic Lupus Erythematosus

Abstract

Background: SLE is a chronic heterogenous systemic autoimmune disease associated with significant morbidity and poor health related quality of life. Chronic sleep disturbances have been found to have detrimental effects on health and functioning. In this study we aim to evaluate and compare the sleep quality in SLE patients vs. healthy controls using validated sleep questionnaires in the Indian population. Methods: We assessed sleep quality in enrolled SLE patients and age-sex matched controls using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness score. Data on demographics, quality of life (QoL) and functional disability was collected using the WHO QoL Brief version and Health assessment Questionnaire (HAQ)-CRD version. Disease severity i.e. activity and damage scores were recorded during clinical examination. Results: 90 cases and 90 controls were enrolled in this study. In cases, the mean age was 37.11 ± 13.01 years with 90% females, average disease duration of 7.12 ± 6.65 years, SLEDAI-2k of 4.01± 3.72 (i.e. mild disease) and SLICC-DI of 0.40± 0.76 (Table 1). 72.2% cases had Musculo-skeletal involvement, 50% has mucocutaneous, 30% had nephritis and 25.6% had hematological abnormalities as primary complaints. Few cases had serositis (5.6%), gangrene (2.2%), anti-phospholipid syndrome (3.3%) and pulmonary involvement (3.3%). Cases demonstrated worse sleep quality than controls with a mean PSQI of 7.59± 3.33 vs 4.52± 2.90 respectively (p[Formula: see text]0.001). 82.2% (n=74) cases had PSQI score [Formula: see text]4. Cases also had poorer PSQI component scores i.e. quality, latency, disturbances, medication use and daytime dysfunction (p[Formula: see text]0.001). Epworth sleepiness score was significantly higher in the SLE group (4.68± 3.31 vs 2.19± 2.55) (Table 2). Poor sleep quality was associated with lower WHO QoL domain scores and higher HAQ scores (p[Formula: see text]0.001). Significant association was found between disease activity (SLEDAI-2K) and PSQI total score (p=0.027), but no such correlation was found with organ involvement or total damage. Conclusion: Sleep quality was significantly worse in SLE patients than controls. This was associated with overall poor quality of life and physical function. Given that sleep is multifactorial; symptoms such as fatigue, myalgia, joint pains and rashes significantly affect sleep but maybe missed on standard disease indices. Poor sleep translates into poor general health which the patient may experience despite controlled disease.