Balderas-Díaz Sara, Martínez M Pilar, Guerrero-Contreras Gabriel, Miró Elena, Benghazi Kawtar, Sánchez Ana I, Garrido José Luis, Prados Germán
Sara Balderas-Díaz, CITIC-UGR Office I1-11, C/ Periodista Rafael Gómez Montero, Nº 2, University of Granada, 18014 Granada, Spain, E-mail:
Methods Inf Med. 2017 Mar 23;56(2):171-179. doi: 10.3414/ME16-02-0011. Epub 2017 Jan 24.
Although sleep alterations can be an important factor contributing to the clinical state of Systemic Lupus Erythematosus, there are no studies to adequately assess sleep quality in this type of disease.
The aim of this work is to analyse the sleep quality of Systemic Lupus Erythematous (SLE) patients based on more objective information provided by actigraphy and mobile systems. The idea is to carry out a comprehensive study by analysing how environmental conditions and factors can affect sleep quality.
In traditional methods the information for assessing sleep quality is obtained through questionnaires. In this work, a novel method is proposed by combining these questionnaires that provide valuable but subjective information with actigraphy and a mobile system to collect more objective information about the patient and their environment. The method provides mechanisms to detect how sleep hygiene could be associated directly with the sleep quality of the subjects, in order to provide a custom intervention to SLE patients. Moreover, this alternative provides ease of use, and non-intrusive ICT (Information and Communication Technology) through a wristband and a mHealth system. The mHealth system has been developed for environmental conditions sensing. This consists of a mobile device with built-in sensors providing input data about the bedroom environment during sleep, and a set of services of the Environmental Monitoring System for properly managing the configuration, registration and fusion of those input data. In previous studies, this information has never been taken into account. However, the information could be relevant in the case of SLE patients. The sample is composed of 9 women with SLE and 11 matched controls with a mean age of 35.78 and 32.18, respectively. Demographic and clinical variables between SLE patients and healthy controls are compared using the Fisher exact test and the Mann-Whitney U test. Relationships between psychological variables, actigraphy measures, and variables related to environmental conditions are analysed with Spearman's rank correlation coefficient.
The SLE group showed poorer sleep quality, and more pain intensity, fatigue and depression than the healthy controls. Significant differences between SLE women and healthy controls in measures of actigraphy were not found. However, the fusion of the measures of the environmental conditions that were collected by the mobile system and actigraphy, has shown that light, and more specifically temperature have a direct relation with several measures of actigraphy which are related to sleep quality. It should be emphasize this result because usually the sleep problems are assessment through self-reported measures which had not revealed this association. Moreover, there are no previous studies that analyse these aspects in bedroom environments of SLE patients directly from objective measures.
The results indicate the need to complement the subjective evaluation of sleep with objective measures. The use of actigraphy in combination with a new mHealth system provides a complete assessment especially relevant to chronic conditions as SLE. Both systems incorporate this objective information directly from objective measures in a non-intrusive way. Moreover, the measures of bedroom environmental variables provide useful and relevant clinical information to assess what is happening daily and not occasionally. This could lead to more customized interventions and adapt the treatment to each individual.
尽管睡眠改变可能是导致系统性红斑狼疮临床状态的一个重要因素，但尚无研究充分评估此类疾病的睡眠质量。
本研究旨在基于活动记录仪和移动系统提供的更客观信息，分析系统性红斑狼疮（SLE）患者的睡眠质量。其思路是通过分析环境条件和因素如何影响睡眠质量来开展一项全面研究。
传统方法通过问卷获取评估睡眠质量的信息。在本研究中，提出了一种新方法，即将提供有价值但主观信息的问卷与活动记录仪和移动系统相结合，以收集关于患者及其环境的更客观信息。该方法提供了检测睡眠卫生如何与受试者睡眠质量直接相关的机制，以便为SLE患者提供定制化干预。此外，这种方法使用方便，通过腕带和移动健康系统实现非侵入式信息通信技术（ICT）。移动健康系统是为环境条件感知而开发的。它由一个内置传感器的移动设备组成，该设备在睡眠期间提供有关卧室环境的输入数据，以及一套环境监测系统服务，用于正确管理这些输入数据的配置、注册和融合。在以往研究中，从未考虑过这些信息。然而，这些信息可能与SLE患者相关。样本由9名SLE女性患者和11名匹配的对照组成，平均年龄分别为35.78岁和32.18岁。使用Fisher精确检验和Mann-Whitney U检验比较SLE患者和健康对照之间的人口统计学和临床变量。使用Spearman等级相关系数分析心理变量、活动记录仪测量值以及与环境条件相关变量之间的关系。
SLE组的睡眠质量比健康对照组差，疼痛强度、疲劳和抑郁程度更高。未发现SLE女性患者和健康对照在活动记录仪测量值上有显著差异。然而，移动系统收集的环境条件测量值与活动记录仪测量值的融合表明，光线，更具体地说是温度，与一些与睡眠质量相关的活动记录仪测量值有直接关系。应强调这一结果，因为通常睡眠问题是通过自我报告的测量方法进行评估的，而这些方法并未揭示这种关联。此外，以前没有研究直接从客观测量方法分析SLE患者卧室环境中的这些方面。
结果表明需要用客观测量方法补充睡眠的主观评估。将活动记录仪与新的移动健康系统结合使用可提供全面评估，这对SLE等慢性病尤为重要。这两个系统都以非侵入式方式直接从客观测量中纳入这些客观信息。此外，卧室环境变量的测量提供了有用且相关的临床信息，可用于评估日常而非偶尔发生的情况。这可能会带来更定制化的干预措施，并使治疗适合每个个体。
