Guo Genkai, Fu Ting, Yin Rulan, Zhang Lijuan, Zhang Qiuxiang, Xia Yunfei, Li Liren, Gu Zhifeng
Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.
School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China.
Health Qual Life Outcomes. 2016 Nov 16;14(1):151. doi: 10.1186/s12955-016-0550-3.
Poor sleep quality is common in rheumatoid arthritis (RA) patients and may lead to disease aggravation and decreased health-related quality of life (HRQoL). The increasing prevalence of poor sleep in RA patients is associated with adverse demographic, clinical, and psychological characteristics. However, there are currently no known reported studies related to the effects of sleep quality on HRQoL in RA patients from China. This cross-sectional study aims to evaluate the contributors of poor sleep and the effects of sleep quality on HRQoL in Chinese RA patients.
A self-report survey was administered to 131 RA patients and 104 healthy individuals using the Pittsburgh Sleep Quality Index (PSQI) for sleep quality. RA patients completed the Hospital Anxiety and Depression Scale for anxiety and depression, the 28-joint Disease Activity Score for disease activity, the 10 cm Visual Analog Scale for pain, the Health Assessment Questionnaire-Disability Index for functional capacity and the Short Form 36 health survey for HRQoL. Blood samples were taken to gain some biochemical indicators (e.g., erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide). Independent samples t-tests, Chi square analysis, logistic regression modeling and linear regression were used to analyze these data.
Our results found that the prevalence of poor sleep (PSQI ≥ 5) was 78.6% and the mean global score of PSQI was 7.93 (SD 3.98) in patients, which were significantly higher than the controls (18.7% and 3.88 (SD 1.89), respectively). There were significant correlations among synthetic disease-modifying antirheumatic drugs, erythrocyte sedimentation rate, pain, disease activity, functional capacity, anxiety/depression and sleep quality in RA patients. Meanwhile, logistic regression models identified disease activity and depression as predictors of poor sleep quality. Poor RA sleepers had impaired HRQoL than good RA sleepers, and sleep quality was independently and significantly associated with social function and mental components summary.
The majority of Chinese RA patients suffered from poor sleep, which significantly impairs their HRQoL. The data suggested the need for holistic assessment and management of RA patients and the importance of objective interventions to improve their sleep quality and finally to improve their HRQoL.
睡眠质量差在类风湿关节炎（RA）患者中很常见，可能导致疾病加重和健康相关生活质量（HRQoL）下降。RA患者睡眠质量差的患病率不断上升，这与不良的人口统计学、临床和心理特征有关。然而，目前尚无关于中国RA患者睡眠质量对HRQoL影响的报道研究。这项横断面研究旨在评估中国RA患者睡眠质量差的影响因素以及睡眠质量对HRQoL的影响。
使用匹兹堡睡眠质量指数（PSQI）对131例RA患者和104名健康个体进行自我报告调查，以评估睡眠质量。RA患者完成医院焦虑抑郁量表以评估焦虑和抑郁、28个关节疾病活动评分以评估疾病活动度、10厘米视觉模拟量表以评估疼痛、健康评估问卷残疾指数以评估功能能力以及简短健康调查以评估HRQoL。采集血样以获取一些生化指标（如红细胞沉降率、C反应蛋白、类风湿因子和抗环瓜氨酸肽）。使用独立样本t检验、卡方分析、逻辑回归模型和线性回归对这些数据进行分析。
我们的结果发现，患者中睡眠质量差（PSQI≥5）的患病率为78.6%，PSQI的平均总分是7.93（标准差3.98），显著高于对照组（分别为18.7%和3.88（标准差1.89））。RA患者中，合成改善病情抗风湿药物、红细胞沉降率、疼痛、疾病活动度、功能能力、焦虑/抑郁和睡眠质量之间存在显著相关性。同时，逻辑回归模型确定疾病活动度和抑郁是睡眠质量差的预测因素。睡眠质量差的RA患者的HRQoL比睡眠质量好的患者受损更严重，并且睡眠质量与社会功能和心理成分总结独立且显著相关。
大多数中国RA患者睡眠质量差，这严重损害了他们的HRQoL。数据表明需要对RA患者进行全面评估和管理，以及客观干预以改善他们的睡眠质量并最终提高他们的HRQoL的重要性。
