Rheumatology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Rheumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain.
Sci Rep. 2023 Dec 21;13(1):22927. doi: 10.1038/s41598-023-48723-z.
The assessment of psoriatic arthritis is complex and multidimensional. It is increasingly common to include the patient perspective using patient-reported outcomes. Although some research has explored sleep quality in patients with psoriatic arthritis, most studies have had small sample sizes, failed to assess sleep quality considering the inflammatory process together with the psychological well-being of patients, and have not described any use of sleep medication. Further, research to date has not provided data on the relationship of sleep quality with axial forms. In this context, the objective of this study was to assess sleep quality in patients with psoriatic arthritis and its relationship with clinical characteristics, disease activity, functioning, disease impact, fatigue and psychological status. A cross-sectional study was conducted including 247 consecutive patients with PsA recruited during 2021. Sleep quality was measured using the Pittsburgh Sleep Quality Index. We assessed correlations of Pittsburgh Sleep Quality Index score with peripheral disease activity (Disease Activity Index for PSoriatic Arthritis), axial disease activity (Ankylosing Spondylitis Disease Activity Score-C-reactive protein and Bath Ankylosing Spondylitis Disease Activity Index), functioning (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire), impact (Psoriatic Arthritis Impact of Disease questionnaire), anxiety, depression (Hospital Anxiety and Depression Scale) and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) scores. A multiple linear regression model was constructed with PSQI as the dependent variable and as independent variables those that could influence sleep quality. Nearly two-thirds (63.15%) of patients had poor sleep quality. Poorer sleep quality was associated with being female, higher joint counts, greater peripheral and axial disease activity, fatigue, anxiety and depression, functioning and disease impact (p < 0.001). Multiple linear regression analysis found that pain (β: 0.3; p < 0.007) and fatigue β: - 0.1; p < 0.001 contributed 40% to the sleep quality model. Poor sleep quality was common among patients with psoriatic arthritis. Emotional factors (fatigue, anxiety) seemed more important than inflammatory factors in sleep quality.
评估银屑病关节炎是一个复杂且多维的过程。越来越多地采用患者报告的结果来纳入患者的观点。尽管一些研究已经探讨了银屑病关节炎患者的睡眠质量，但大多数研究的样本量较小，未能综合考虑炎症过程以及患者的心理健康状况来评估睡眠质量，也没有描述任何睡眠药物的使用情况。此外，迄今为止的研究还没有提供关于睡眠质量与中轴型疾病之间关系的数据。在这种情况下，本研究的目的是评估银屑病关节炎患者的睡眠质量及其与临床特征、疾病活动度、功能、疾病影响、疲劳和心理状况的关系。这是一项横断面研究，纳入了 2021 年期间招募的 247 例连续的银屑病关节炎患者。使用匹兹堡睡眠质量指数来评估睡眠质量。我们评估了匹兹堡睡眠质量指数评分与外周疾病活动度（银屑病关节炎疾病活动度指数）、中轴疾病活动度（强直性脊柱炎疾病活动度评分- C 反应蛋白和 Bath 强直性脊柱炎疾病活动指数）、功能（Bath 强直性脊柱炎功能指数和健康评估问卷）、疾病影响（银屑病关节炎疾病影响问卷）、焦虑、抑郁（医院焦虑抑郁量表）和疲劳（慢性疾病治疗疲劳功能评估）评分之间的相关性。构建了一个多元线性回归模型，将 PSQI 作为因变量，将可能影响睡眠质量的变量作为自变量。近三分之二（63.15%）的患者睡眠质量较差。较差的睡眠质量与女性、更高的关节计数、更大的外周和中轴疾病活动度、疲劳、焦虑和抑郁、功能和疾病影响有关（p<0.001）。多元线性回归分析发现疼痛（β：0.3；p<0.007）和疲劳（β：-0.1；p<0.001）对睡眠质量模型的贡献为 40%。银屑病关节炎患者中睡眠质量差很常见。与炎症因素相比，情绪因素（疲劳、焦虑）对睡眠质量似乎更为重要。
