Sleep Quality is Poor in Rheumatoid Arthritis Patients and Correlates with Anxiety, Depression, and Poor Quality of Life.

Objective: Sleep quality is poor in most rheumatoid arthritis (RA) patients. We planned this study to see the association of sleep quality with anxiety, depression, and quality of life (QOL) in Indian RA patients.

Methods: One hundred twelve RA patients and 93 controls were included in this cross-sectional study. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI). Quality of life was assessed using the World Health Organisation Quality of Life (WHOQOL-BREF). Anxiety and depression were assessed using the hospital anxiety and depression scale (HADS). The disease activity was measured by Disease Activity Score for 28 joints with 3 variables. Functional disability was measured by using the Indian version of the Health Assessment Questionnaire (HAQ).

Results: Poor sleep quality was seen in 103(92%) of the patients and 26(28%) controls (p<0.0001). RA patients had significantly higher PSQI scores as compared to the control group (10.8±3.7 vs.3.9±1.2, P<0.0001). Poor sleepers were more likely to be females (90% vs.0%, p = 0.02), and had longer disease duration (5.2±4.8 years vs. 2.8±2 years, p=0.01). Poor sleepers had more pain (VAS 42.2±23.6 mm vs.16.2±11.6 mm, p<0.001) and poor functional status (HAQ 1.2±0.5 vs. 0.6±0.4, p<0.01). There was a significant effect of the physical domain of WHOQOL-BREF, anxiety, and age on poor sleep quality.

Conclusion: Poor sleep quality is seen in a majority of RA patients and correlates with anxiety, depression, and poor QOL. RA patients need to be routinely assessed for sleep quality and factors affecting poor sleep quality need to be addressed.