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Research ArticleArticle

Sleep Problems in Patients with Rheumatoid Arthritis

René Westhovens, Kristien Van der Elst, Ann Matthys, Michelle Tran and Isabelle Gilloteau
The Journal of Rheumatology December 2013, jrheum.130430; DOI: https://doi.org/10.3899/jrheum.130430
René Westhovens
From the Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and the Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven, Leuven; Medical Department, Bristol-Myers Squibb, Brussels, Belgium; EJB Systems Inc., Oakville, Ontario, Canada; Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, New Jersey, USA. Supported by Bristol-Myers Squibb. R. Westhovens has received grant/research support and/or fees (for consultancy or for participation in a speakers bureau) from Bristol-Myers Squibb, Centocor Inc., Roche, Schering-Plough, and UCB Inc. A. Matthys and I. Gilloteau are employees of Bristol-Myers Squibb. R. Westhovens, MD, PhD, Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and Rheumatology, University Hospitals of Leuven; K. Van der Elst, MSc, Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven; A. Matthys, MD, Medical Department, Bristol-Myers Squibb; M. Tran, MSc, Consultant, EJB Systems Inc.; I. Gilloteau, MSc, MPH, Global Health Economics and Outcomes Research, Bristol-Myers Squibb. Address correspondence to Prof. R. Westhovens, Rheumatology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. E-mail: rene.westhovens@uzleuven.be. Accepted for publication September 6, 2013.
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Kristien Van der Elst
From the Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and the Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven, Leuven; Medical Department, Bristol-Myers Squibb, Brussels, Belgium; EJB Systems Inc., Oakville, Ontario, Canada; Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, New Jersey, USA. Supported by Bristol-Myers Squibb. R. Westhovens has received grant/research support and/or fees (for consultancy or for participation in a speakers bureau) from Bristol-Myers Squibb, Centocor Inc., Roche, Schering-Plough, and UCB Inc. A. Matthys and I. Gilloteau are employees of Bristol-Myers Squibb. R. Westhovens, MD, PhD, Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and Rheumatology, University Hospitals of Leuven; K. Van der Elst, MSc, Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven; A. Matthys, MD, Medical Department, Bristol-Myers Squibb; M. Tran, MSc, Consultant, EJB Systems Inc.; I. Gilloteau, MSc, MPH, Global Health Economics and Outcomes Research, Bristol-Myers Squibb. Address correspondence to Prof. R. Westhovens, Rheumatology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. E-mail: rene.westhovens@uzleuven.be. Accepted for publication September 6, 2013.
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Ann Matthys
From the Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and the Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven, Leuven; Medical Department, Bristol-Myers Squibb, Brussels, Belgium; EJB Systems Inc., Oakville, Ontario, Canada; Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, New Jersey, USA. Supported by Bristol-Myers Squibb. R. Westhovens has received grant/research support and/or fees (for consultancy or for participation in a speakers bureau) from Bristol-Myers Squibb, Centocor Inc., Roche, Schering-Plough, and UCB Inc. A. Matthys and I. Gilloteau are employees of Bristol-Myers Squibb. R. Westhovens, MD, PhD, Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and Rheumatology, University Hospitals of Leuven; K. Van der Elst, MSc, Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven; A. Matthys, MD, Medical Department, Bristol-Myers Squibb; M. Tran, MSc, Consultant, EJB Systems Inc.; I. Gilloteau, MSc, MPH, Global Health Economics and Outcomes Research, Bristol-Myers Squibb. Address correspondence to Prof. R. Westhovens, Rheumatology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. E-mail: rene.westhovens@uzleuven.be. Accepted for publication September 6, 2013.
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Michelle Tran
From the Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and the Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven, Leuven; Medical Department, Bristol-Myers Squibb, Brussels, Belgium; EJB Systems Inc., Oakville, Ontario, Canada; Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, New Jersey, USA. Supported by Bristol-Myers Squibb. R. Westhovens has received grant/research support and/or fees (for consultancy or for participation in a speakers bureau) from Bristol-Myers Squibb, Centocor Inc., Roche, Schering-Plough, and UCB Inc. A. Matthys and I. Gilloteau are employees of Bristol-Myers Squibb. R. Westhovens, MD, PhD, Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and Rheumatology, University Hospitals of Leuven; K. Van der Elst, MSc, Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven; A. Matthys, MD, Medical Department, Bristol-Myers Squibb; M. Tran, MSc, Consultant, EJB Systems Inc.; I. Gilloteau, MSc, MPH, Global Health Economics and Outcomes Research, Bristol-Myers Squibb. Address correspondence to Prof. R. Westhovens, Rheumatology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. E-mail: rene.westhovens@uzleuven.be. Accepted for publication September 6, 2013.
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Isabelle Gilloteau
From the Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and the Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven, Leuven; Medical Department, Bristol-Myers Squibb, Brussels, Belgium; EJB Systems Inc., Oakville, Ontario, Canada; Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, New Jersey, USA. Supported by Bristol-Myers Squibb. R. Westhovens has received grant/research support and/or fees (for consultancy or for participation in a speakers bureau) from Bristol-Myers Squibb, Centocor Inc., Roche, Schering-Plough, and UCB Inc. A. Matthys and I. Gilloteau are employees of Bristol-Myers Squibb. R. Westhovens, MD, PhD, Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, and Rheumatology, University Hospitals of Leuven; K. Van der Elst, MSc, Center for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, and Rheumatology, University Hospitals of Leuven; A. Matthys, MD, Medical Department, Bristol-Myers Squibb; M. Tran, MSc, Consultant, EJB Systems Inc.; I. Gilloteau, MSc, MPH, Global Health Economics and Outcomes Research, Bristol-Myers Squibb. Address correspondence to Prof. R. Westhovens, Rheumatology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. E-mail: rene.westhovens@uzleuven.be. Accepted for publication September 6, 2013.
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Abstract

Objective To investigate sleep problems, and the relationship between sleep and disease activity, in Belgian patients with established rheumatoid arthritis (RA).

Methods This cross-sectional, observational, multicenter study assessed sleep quality using the Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI), and daytime sleepiness using the Epworth Sleepiness Scale (ESS). Additional patient-reported outcomes included visual analog scales (VAS) for fatigue and pain, the Medical Outcomes Study Short Form-36 Health Survey, the Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Positive and Negative Affect Schedule. Multivariate regression and structural equation modeling identified factors associated with sleep quality, with the 28-joint Disease Activity Score [DAS28-C-reactive protein (CRP)] as a continuous or categorical variable. Analyses were performed on the total population and on patients stratified by disease activity status: remission/low (DAS28-CRP ≤ 3.2) or moderate to high (DAS28-CRP > 3.2).

Results Among 305 patients, mean (SD) age was 57.00 (12.38) years and mean (SD) disease duration was 11.77 (9.94) years. Mean (SD) AIS, PSQI, and ESS scores were 6.8 (4.79), 7.8 (4.30), and 7.3 (4.67), respectively. Mean (SD) VAS fatigue, VAS pain, and HAQ-DI were 45.22 (26.29), 39.04 (26.21), and 1.08 (0.75), respectively. There were significant positive relationships between DAS28-CRP and AIS/PSQI, but a significant negative relationship between DAS28-CRP and ESS. Several potentially confounding factors were identified.

Conclusion Poor control of RA is associated with a reduction in sleep quality and decreased daytime sleepiness, which is likely explained by pain-related alertness. Future prospective studies are needed to confirm potential relationships between sleep quality, sleepiness, and RA treatment.

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Sleep Problems in Patients with Rheumatoid Arthritis
René Westhovens, Kristien Van der Elst, Ann Matthys, Michelle Tran, Isabelle Gilloteau
The Journal of Rheumatology Dec 2013, jrheum.130430; DOI: 10.3899/jrheum.130430

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Sleep Problems in Patients with Rheumatoid Arthritis
René Westhovens, Kristien Van der Elst, Ann Matthys, Michelle Tran, Isabelle Gilloteau
The Journal of Rheumatology Dec 2013, jrheum.130430; DOI: 10.3899/jrheum.130430
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