RESEARCH - Sleep disturbance in patients with RA: evaluation by medical outcomes study and visual analog sleep scales

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J Rheumatol. 2006 Oct;33(10):1942-51. Epub 2006 Sep 1.

Sleep disturbance in patients with rheumatoid arthritis: evaluation by

medical outcomes study and visual analog sleep scales.

Wolfe F, Michaud K, Li T.

From the National Data Bank for Rheumatic Diseases, University of Kansas

School of Medicine, Wichita, Kansas; Stanford University, Stanford,

California; and Bristol-Myers Squibb, Princeton, New Jersey, USA.

OBJECTIVE: Except for some polysomnography studies, there have been no large

quantitative studies of sleep disturbance (SD) in rheumatoid arthritis (RA).

SD has taken on new importance with the observation that etanercept and

infliximab reduce daytime sleepiness, and patient groups indicate that sleep

is an important issue. METHODS: We evaluated 8676 patients with RA and a

comparison group of 1364 subjects with non-fibromyalgia, noninflammatory

disorders (NID) using the Medical Outcome Study (MOS) sleep questionnaire,

including 2 MOS sleep problem indexes (SPI-I, SPI-II) and the MOS SD scale.

In addition, patients completed a visual analog scale (VAS) sleep

disturbance scale (SDS). RESULTS: The scales had similar mean values: SPI-I

35.4 (19.4), SPI-II 36.0 (19.1), SDS 35.0 (24.7), and VAS sleep 36.1 (29.7),

and the values for the MOS scales exceeded population norms by 25% (VAS by

42%). In multivariable analyses SD was primarily determined by pain and

mood. Patients receiving anti-tumor necrosis factor (TNF) did not have less

abnormal sleep scores. SD was comparable in RA and NID. The VAS scale was

more strongly associated with RA clinical variables than the MOS scales;

however, the distributional characteristics of the scales differed, with the

VAS scales capturing more extreme values. The standard error of the

measurement (SEM), which is related to minimal (important) change, was SPI-I

9.0, SPI-II 7.3, SDS 9.6, and VAS sleep 10.4.

CONCLUSION: SD is increased in RA, and 25% to 42% of SD can be attributed to

RA. SD is linked to pain, mood, and disease activity. SD is slightly greater

in women and is less with increasing age. All scales appear to be valid in

RA, with minimal differences in SEM.

PMID: 16960928

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6960928

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