Sleep, depression, anxiety and quality of life in patients with systemic lupus erythematosus

Aim of the work

To study the frequency of sleep quality in a cohort of Brazilian Systemic lupus erythematosus (SLE) patients and to investigate its associations with clinical characteristics, disease activity, mood disorders (anxiety and depression) and quality of life (QoL).

Patients and methods

A sample of 59 SLE patients and 76 controls answered the Pittsburg Sleep Quality Index (PSQI), Center for epidemiological studies-depression (CES-D) questionnaire, Hamilton rating scale for anxiety (HAM-A), and the 12-item short form (SF-12) survey for QoL. Clinical characteristics, SLEDAI (SLE disease activity index) and comorbidities were recorded.

Results

The mean age of the patients was 42.3 ± 12.6 years and 55 were females (F:M 13.8:1). 62.7 % were Caucasian, 23.7 % were tobacco exposed, 30.5 % hypertensive, 22 % had dyslipidemia, 16.9 % hypothyroid and 10.1 % diabetic. The median SLEDAI was 0 (0–2), CES-D 17 (14–25), HAM-A 20.6 ± 10.2, SF-12 physical component was 38.4 (30.1–52.2) and mental 42.4 ± 12.3. 78.2 % (43/59) of patients were poor sleepers vs 50 % (38/76) of controls (p = 0.01). PSQI correlated with HAM-A (p = 0.0006), CES-D (p = 0.0005) and SF-12 (both components: mental p = 0.009 and physical p = 0.004) but not with SLEDAI (p = 0.25). Regarding Pittsburg domains, a significant correlation was found with between HMA-A and subjective sleep (r = 0.38; p = 0.03), sleep disturbances (r = 0.44 and p = 0.0004) and daytime dysfunction (r = 0.48; p = 0.0005) and between CES-D and sleep latency (r = 0.38; p = 0.02), sleep disturbances (r = 0.3; p = 0.01) and day time dysfunction (r = 0.5; p < 0.0001).

Conclusion

There is a high frequency of sleep disturbances in the SLE group that was worse in individuals with depression and anxiety, suggesting a reduction in QoL.