Clinical ReviewSleep and rheumatologic disorders
Introduction
Arthritis is the most common chronic condition and the leading cause of disability in the United States. At least 66 million Americans have reported chronic joint symptoms or arthritic complaints. Arthritis prevalence increases with age, afflicting 40% of adults aged 55 to 64 and 52% of adults aged 65 and older. Many arthritis sufferers complain of poor sleep. In a 2003 Sleep in America Poll, 72% of adults aged 55 years and older with arthritis reported the following: short sleep, less than 6 h per night (15%); daytime sleepiness (18%); diagnosed sleep disorder (18%); restless legs sensations (24%); poor to fair quality sleep (29%); and insomnia (56%). This review provides a general overview of various rheumatologic disorders (rheumatoid arthritis, juvenile rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, scleroderma, Behcet's disease, seronegative spondyloarthropathies, osteoarthritis, sarcoidosis, and fibromyalgia) and their associated sleep problems (Table 1). Among the above disorders, rheumatoid arthritis and fibromyalgia have been investigated more extensively from the sleep standpoint and a significant portion of this review is devoted to these diseases, although the rheumatological significance of fibromyalgia remains controversial. The inter-relationships between sleep complaints, pain, depression, sleep deprivation, disease activity, and cytokines are discussed. Our intent is to highlight what is known and what is not known about sleep and rheumatologic disorders and to underscore the need for more research to enhance our understanding of these complex issues.
Section snippets
Rheumatoid arthritis (RA)
Rheumatoid arthritis affects 3 million adults in the United States, with women being affected 2.5 times more frequently than men. RA is a systemic autoimmune disease characterized by symmetric polyarthritis affecting 3 or more joints, early morning stiffness, rheumatoid nodules, rheumatoid factor, and radiographic erosions and/or periarticular osteopenia in metacarpophalangeal and/or wrist joints.
Sleep complaints and related daytime symptoms occur in 54–70% of adult RA patients,1 including
Covariation of rheumatologic disorders, sleep complaints, and sleep disorders—common threads and implications
Our review of rheumatologic disorders comes back full circle to a commonality of sleep complaints—insomnia with difficulty falling asleep, sleep fragmentation with multiple arousals/awakenings, poor quality sleep, and daytime complaints of excessive sleepiness or fatigue. Intertwined with arthritis are pain, depression, inflammation, and potentially, sleep deprivation.
Conclusion
Sleep complaints are an important part of the symptomatology of rheumatologic disorders. Nocturnal sleep disruption is a common finding, and it is expressed in the analysis of the sleep EEG. It leads to different complaints. However, the roles that sleep disorders and sleep disruption play in worsening the rheumatologic processes are still poorly understood and little explored. Controlling the sleep disturbance and decreasing its impact may not only improve the quality of life of patients with
References (78)
- et al.
Sleep disruption in systemic sclerosis (scleroderma) patients: clinical and polysomnographic findings
Sleep Med
(2002) - et al.
An assessment of sleep disturbance in patients before and after total hip arthroplasty
J Arthroplasty
(2003) - et al.
Cytokines in the rheumatic diseases
Rheum Dis Clin North Am
(2004) Cytokines and sleep
Sleep Med Rev
(2005)- et al.
Cellular adhesion molecule expression, nocturnal sleep, and partial night sleep deprivation
Brain Behav Immun
(2004) Sleep and psychiatric disorders: future directions
Psychiatr Clin North Am
(2006)- et al.
How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature
Sleep Med Rev
(2004) - et al.
A blind, randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity
Pain
(2001) - et al.
Sleep disturbances, fatigue, depression, and heart rate variability in menopausal women with and without RA
Sleep
(2005) - et al.
Sleep in rheumatoid arthritis: a comparison with healthy subjects and studies of sleep/wake interactions
Br J Rheumatol
(1998)
Objective and subjective sleep disturbances in patients with rheumatoid arthritis. A reappraisal
Arthritis Rheum
Alpha EEG sleep and morning symptoms in rheumatoid arthritis
J Rheumatol
Actigraphic measurements of sleep in rheumatoid arthritis: comparison of patients with low back pain and healthy controls
J Rheumatol
A longitudinal study of clinical symptoms and sleep parameters in rheumatoid arthritis
Rheumatology (Oxford)
Effects of triazolam on sleep, daytime sleepiness, and morning stiffness in patients with rheumatoid arthritis
J Rheumatol
Sleep fragmentation in rheumatoid arthritis
Arthritis Rheum
Factors which contribute to fatigue associated with rheumatoid arthritis
J Adv Nurs
Nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis patients. Lack of association between clinical improvement and effects on sleep
Arthritis Rheum
The Nottingham Health Profile as a measure of disease activity and outcome in rheumatoid arthritis
Br J Rheumatol
Sleep disturbance in patients with rheumatoid arthritis: evaluation by medical outcomes study and visual analog sleep scales
J Rheumatol
Sleep misperception in patients with rheumatoid arthritis (abstract)
Sleep Med
Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis
J Abnorm Psychol
Sleep quality and immune functions in rheumatoid arthritis patients with and without major depression
Int J Neurosci
Upper airway obstruction in patients with rheumatoid arthritis and temporomandibular joint destruction
Scan J Rheumatol
Sleep disturbances in patients with primary Sjogren's syndrome
Br J Rheumatol
Sleep apnoea caused by rheumatoid arthritis
Br J Rheumatol
Restless legs syndrome in rheumatoid arthritis
Sleep
Sleep fragmentation in children with juvenile rheumatoid arthritis
J Rheumatol
Facioskeletal changes in children with juvenile idiopathic arthritis
Ann Rheum Dis
Sleep disturbances, fibromyalgia and primary Sjogren's syndrome
Clin Exp Rheumatol
Anxiety and depression in patients with primary Sjogren's syndrome
J Rheumatol
The prevalence and associations of fatigue in systemic lupus erythematosus
Rheumatology (Oxford)
Determinants of sleep quality in women with systemic lupus erythematosus
Arthritis Rheum
Objective and subjective sleep disturbances in patients with systemic lupus erythematosus
Arthritis Rheum
Disordered sleep, sleepiness, and depression in chroically tired patients with systemic lupus erythematosis
Sleep
Thalidomide in the treatment of the mucocutaneous lesions of the Behcet syndrome. A randomized, double-blind, placebo-controlled trial
Ann Intern Med
Sleep apnea and palatal myoclonus in a patient with neuro-Behcet syndrome
Intern Med
On psychiatric symptoms of neuro-Behcet's syndrome
Folia Psychiatr Neurol Jpn
Cited by (247)
The risk factors for probable REM sleep behavior disorder: A case-control study
2023, Sleep MedicineSleep quality as a mediator of the relation between depression and chronic pain: a systematic review and meta-analysis
2023, British Journal of AnaesthesiaTemporomandibular Joint Disorder Comorbidities
2023, Dental Clinics of North AmericaMorbidity and mortality
2023, Encyclopedia of Sleep and Circadian Rhythms: Volume 1-6, Second Edition
- *
The most important references are denoted by an asterisk.