Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. Ramiro Barcelos 2350, 90035-903 Porto Alegre, Brazil.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Oxford OX3 7LD Oxford, United Kingdom.
Joint Bone Spine. 2020 Oct;87(5):449-454. doi: 10.1016/j.jbspin.2020.03.014. Epub 2020 Apr 10.
Sleep quality is diminished in patients with psoriatic arthritis (PsA) and close to 40% of PsA patients consider sleep difficulties a priority domain. This work analyzes determinants of impaired sleep in patients with PsA.
This was a cross-sectional analysis of an observational study (ReFlap, NCT NCT03119805), which included adult patients with definite PsA with≥2 years disease duration from 14 countries. Sleep was assessed using the patient self-reported evaluation of sleep on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12). A score≥4 was considered as sleep impairment. Demographic and clinical variables associated to sleep impairment were assessed through univariate analysis and Poisson regression modeling leading to prevalence ratio (PR) [95% confidence interval].
A total of 396 patients were analyzed: mean age 51.9±12.6 years, 51% were females, 59.7% were receiving biologic therapy, 53.3% had 1-5% of body surface area affected by psoriasis; 23.7% were in remission and 36.9% in low disease activity according to the Disease Activity in Psoriatic Arthritis (DAPSA) score. Median (25th-75th) patient's self-evaluation of sleep difficulties was 2 (0-6), 157 (39.6%) had sleep impairment. In the Poisson regression model, self-reported levels of anxiety (PR: 1.05 [1.02-1.08], P=0.003) and pain (PR: 1.06 [1.04-1.09], P<0.001) were independently associated to sleep impairment.
In this multicentric study, sleep impairment was present in 40% of PsA patients; pain and anxiety were associated to sleep impairment whereas inflammation was not. Impact on sleep appears multifactorial in PsA.
银屑病关节炎（PsA）患者的睡眠质量下降，近 40%的 PsA 患者认为睡眠困难是优先考虑的问题。本研究分析了 PsA 患者睡眠障碍的决定因素。
这是一项来自于观察性研究（ReFlap，NCT03119805）的横断面分析，纳入了来自 14 个国家的患有明确的 PsA 且疾病持续时间≥2 年的成年患者。睡眠通过患者在 0-10 的数字量表上自我报告的睡眠评估进行评估，包括在银屑病关节炎疾病影响问卷（PSAID-12）中。评分≥4 被认为是睡眠障碍。通过单变量分析和泊松回归模型评估与睡眠障碍相关的人口统计学和临床变量，得出患病率比（PR）[95%置信区间]。
共分析了 396 名患者：平均年龄 51.9±12.6 岁，51%为女性，59.7%接受生物治疗，53.3%有 1-5%的体表面积受银屑病影响；23.7%处于缓解期，36.9%根据疾病活动度在银屑病关节炎（DAPSA）评分中处于低疾病活动期。患者自我报告的睡眠困难程度中位数（25-75 分位数）为 2（0-6），157 人（39.6%）存在睡眠障碍。在泊松回归模型中，自我报告的焦虑水平（PR：1.05[1.02-1.08]，P=0.003）和疼痛（PR：1.06[1.04-1.09]，P<0.001）与睡眠障碍独立相关。
在这项多中心研究中，40%的 PsA 患者存在睡眠障碍；疼痛和焦虑与睡眠障碍相关，而炎症则没有。睡眠障碍在 PsA 中似乎是多因素的。
