Taylor-Gjevre R M, Gjevre J A, Nair B, Skomro R, Lim H J
Division of Rheumatology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Musculoskeletal Care. 2011 Sep;9(3):152-9. doi: 10.1002/msc.208. Epub 2011 Jun 5.
Poor sleep is increasingly recognized as contributing to a decreased quality of life, increased morbidity/mortality and heightened pain perception. The purpose of the present study was to assess components of sleep quality and self-identified contributors to sleep fragmentation in rheumatoid arthritis (RA) and osteoarthritis (OA) patient populations.
Consecutive RA and OA clinic patients were invited to participate in a self-administered questionnaire study which included the validated multi-domain Pittsburgh Sleep Quality Index (PSQI), visual analogue scales for pain, fatigue, global functioning, modified Health Assessment Questionnaire (mHAQ), stress scores, the Centre for Epidemiologic Studies-Depression (CES-D) score, the 36-item short form (SF-36) quality of life measure, the Rheumatoid Arthritis Disease Activity Index (RADAI), the Epworth Sleepiness Scale (ESS), Berlin score for obstructive sleep apnoea (OSA) risk and the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria.
The study population included 145 RA and 78 OA patients. PSQI global scores were >5 in 62% of RA and 67% of OA patients. Multivariate analysis identified global functioning and the CES-D to be independent predictors for higher global PSQI scores in RA patients, whereas in OA patients predictors were the mHAQ and SF-36 mental component summary. Abnormalities in subjective sleep assessment, sleep latency, sleep duration, sleep efficiency, daytime dysfunction and increased sleep-aid medication use were observed in both populations. The most common abnormality reported by both RA and OA patients was increased sleep fragmentation. The most frequent self-identified cause for sleep disturbance was 'need to use the washroom' by 51% of RA and 49% of OA patients, and, second most common, 'pain' was identified as a cause for awakening by 33% of RA and 45% of OA patients.
A high prevalence of abnormal sleep quality in both RA and OA patient populations was observed. The most common abnormality was sleep fragmentation, with an increased sleep disturbance score. 'Need to use the washroom' and 'pain' were the most common self-identified reasons for awakening from sleep. A review of sleep hygiene, optimization of urological status, and rheumatological disease symptomatic control may prove beneficial in terms of sleep health.
睡眠不佳越来越被认为会导致生活质量下降、发病率/死亡率增加以及疼痛感知增强。本研究的目的是评估类风湿关节炎（RA）和骨关节炎（OA）患者群体中睡眠质量的组成部分以及自我认定的睡眠碎片化影响因素。
连续就诊的RA和OA门诊患者被邀请参与一项自填式问卷调查研究，该研究包括经过验证的多领域匹兹堡睡眠质量指数（PSQI）、疼痛视觉模拟量表、疲劳量表、整体功能量表、改良健康评估问卷（mHAQ）、压力评分、流行病学研究中心抑郁量表（CES - D）评分、36项简短健康调查（SF - 36）生活质量测量量表、类风湿关节炎疾病活动指数（RADAI）、爱泼华嗜睡量表（ESS）、阻塞性睡眠呼吸暂停（OSA）风险的柏林评分以及国际不宁腿综合征研究组（IRLSSG）诊断标准。
研究人群包括145例RA患者和78例OA患者。62%的RA患者和67%的OA患者PSQI全球评分>5。多变量分析确定，整体功能和CES - D是RA患者PSQI全球评分较高的独立预测因素，而在OA患者中，预测因素是mHAQ和SF - 36心理成分总结。在这两个人群中均观察到主观睡眠评估、入睡潜伏期、睡眠时间、睡眠效率、日间功能障碍以及助眠药物使用增加等方面的异常。RA和OA患者报告的最常见异常是睡眠碎片化增加。RA患者中有51%、OA患者中有49%自我认定的最常见睡眠干扰原因是“需要上厕所”，其次最常见的是“疼痛”，RA患者中有33%、OA患者中有45%将其确定为觉醒原因。
在RA和OA患者群体中均观察到睡眠质量异常的高患病率。最常见的异常是睡眠碎片化，睡眠干扰评分增加。“需要上厕所”和“疼痛”是自我认定的最常见睡眠觉醒原因。就睡眠健康而言，审查睡眠卫生、优化泌尿系统状况以及控制风湿性疾病症状可能被证明是有益的。
