Chalupczak Natalia V, Aydemir Burcu, Isaacs Ariel, Muhammad Lutfiyya N, Song Jing, Reid Kathryn J, Grimaldi Daniela, Carns Mary, Dennis-Aren Kathleen, Dunlop Dorothy D, Wallace Beth I, Zee Phyllis C, Lee Yvonne C
Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA.
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Arthritis Care Res (Hoboken). 2025 Jun 2. doi: 10.1002/acr.25579.
Fatigue is a prevalent and debilitating symptom for patients with rheumatoid arthritis (RA). While patients and rheumatologists often attribute fatigue to inflammation, other factors such as sleep disturbances are frequently overlooked. This study aims to explore the relationship between subjective (self-reported) and objective (actigraphy-based) sleep parameters and self-reported fatigue in patients with RA.
This cross-sectional analysis included data from 48 adult RA patients from a single academic rheumatology practice. Sleep data were obtained daily over 14 days with actigraphy (objective) and the Karolinska Sleep Diary (subjective). Fatigue was assessed using the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue computerized adaptive test. Spearman's correlations and linear regression analyses were used to examine associations between sleep parameters and fatigue, adjusting for swollen joint count, pain intensity, and symptoms of depression.
Subjective sleep parameters showed significant correlations with PROMIS fatigue. Longer total sleep time (ρ = -0.4, p < 0.01), higher sleep efficiency (ρ = -0.42, p < 0.01), and better sleep quality (ρ = -0.5, p < 0.01) were associated with lower levels of fatigue. Objective actigraphy-based sleep parameters were not significantly associated with PROMIS fatigue. Separate linear regression models demonstrated that each subjective sleep parameter remained significantly associated with fatigue after adjusting for covariates.
Self-reported poor sleep duration, efficiency, and quality were significantly associated with fatigue in patients with RA, whereas objective actigraphy-based sleep parameters were not, supporting the integration of self-reported assessment of sleep disturbances into RA treatment plans to improve patient outcomes.
疲劳是类风湿关节炎（RA）患者中普遍存在且使人衰弱的症状。虽然患者和风湿病学家常常将疲劳归因于炎症，但诸如睡眠障碍等其他因素却经常被忽视。本研究旨在探讨RA患者主观（自我报告）和客观（基于活动记录仪）睡眠参数与自我报告的疲劳之间的关系。
这项横断面分析纳入了来自单一学术风湿病诊所的48例成年RA患者的数据。通过活动记录仪（客观）和卡罗林斯卡睡眠日记（主观）在14天内每日获取睡眠数据。使用患者报告结局测量信息系统（PROMIS）疲劳计算机自适应测试评估疲劳。采用Spearman相关性分析和线性回归分析来检验睡眠参数与疲劳之间的关联，并对关节肿胀计数、疼痛强度和抑郁症状进行校正。
主观睡眠参数与PROMIS疲劳显著相关。总睡眠时间越长（ρ = -0.4，p < 0.01）、睡眠效率越高（ρ = -0.42，p < 0.01）以及睡眠质量越好（ρ = -0.5，p < 0.01）与较低水平的疲劳相关。基于活动记录仪的客观睡眠参数与PROMIS疲劳无显著关联。单独的线性回归模型表明，在校正协变量后，每个主观睡眠参数仍与疲劳显著相关。
自我报告的睡眠持续时间、效率和质量差与RA患者的疲劳显著相关，而基于活动记录仪的客观睡眠参数则不然，这支持将自我报告的睡眠障碍评估纳入RA治疗计划以改善患者结局。
