Poor Sleep Linked to Fatigue and Disease Activity in Primary Sjögren’s

Iqra Mumal, MSc avatar

by Iqra Mumal, MSc |

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Poor sleep quality is linked to both fatigue and increased disease activity in primary Sjögren’s syndrome patients, a study reported.

Its researchers recommend more study into ways that might help patients with difficulty sleeping, a common problem in this disease.

The study, “Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögren’s syndrome: a cross-sectional study,” was published in the Sao Paulo Medical Journal.

Fatigue is a frequent symptom of primary Sjögren’s syndrome — in about 70% of cases, fatigue reaches disabling levels, affecting patients’ physical activities and cognitive abilities.

Several studies also confirmed that a high proportion of Sjögren’s patients suffer from sleep disorders.

A team led by researchers at the Universidade Federal de São Paulo, in Brazil, designed a clinical trial (NCT03130062) investigating the effectiveness of resistance exercise in improving daily motor abilities and functional status in 50 women, average age of 56.4, with primary Sjögren’s.

The trial, which ended in 2017, also assessed sleep quality, fatigue, and disease activity in this patient group.

Sleep quality was measured using the Pittsburg sleep quality index (PSQI), a self-reported questionnaire, and via actigraphy, which uses a wrist device to determine sleep patterns by recording motor activity through limb movements.

Fatigue was evaluated through a questionnaire called Profile of Fatigue and Discomfort – Sicca Symptoms Inventory (PROFAD-SSI-SF), and a visual analogue scale for fatigue (VAS-fatigue).

Disease activity was measured using a visual analogue scale for pain (VAS-pain), EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), and the Disease Activity Index (ESSDAI).

Most participants (80%) were found to have had low disease activity, while the remaining 20% had moderate disease activity. Consistent with prior studies, 75% reported high levels of physical fatigue, and more than half (65%) reported mental fatigue.

Only a quarter of these people (26%) reported good sleep quality on the PSQI questionnaire. Actigraphy results indicated that patients took an average of 26.2 minutes to fall asleep, and were awake during the night for an average of 48.2 minutes. Most slept for about 6.5 hours each, and sleep efficiency was 89.7%.

Looking at any potential links among measures of sleep quality, fatigue, and disease activity, researchers found that PSQI scores significantly correlated with the two measures of fatigue (VAS-fatigue and PROFAD-SSI-SF), as well as with two of the three measures of disease activity (VAS-pain and ESSPRI).

Likewise, actigraphy results showed a significant, but weak, correlation between disturbed sleep (waking during the night) and one measure of disease activity (ESSDAI).

These results, they said, indicated poorer sleep quality was linked to both fatigue and increased disease activity.

“It could be seen that the subjects with the disease presented severe fatigue and sleep disorders. The results also demonstrated that sleep may have an influence on fatigue, and that there is an association between disease activity and sleep,” they wrote.

The researchers emphasized “a need for proper control over disease activity, and for development of strategies to help patients to sleep better in order to diminish their fatigue and improve their quality of life.”