Increased prevalence of sleep disturbance in psoriatic arthritis is associated with inflammatory and non-inflammatory measures

Abstract

Objectives

To examine the prevalence of sleep disturbances, quantified by the Pittsburgh Sleep Quality Index (PSQI), in patients with psoriatic arthritis (PsA), psoriasis (PsO) and healthy controls (HCs), explore associations between PSQI and clinical and patient-reported outcomes, and evaluate the effect of treatment on PSQI.

Method

Patients were included from the Parker Institute’s PsA patient cohort to evaluate the prevalence of sleep disturbances. Univariate and multivariate regression analyses were used to explore associations between sleep disturbance and outcome measures. Treatment effect in PsA patients was assessed with a mixed-effect model for repeated measures.

Results

In total, 109 PsA patients, 20 PsO patients, and 20 HCs were included. Sleep disturbances were reported by 66.1% of PsA patients, 45.0% of PsO patients, and 15.0% of HCs. Univariate regression analyses revealed statistically significant associations (p < 0.001) between PSQI and Disease Activity Score (DAS28CRP), tender points, visual analogue scale (VAS) patient global and pain, Psoriatic Arthritis Impact of Disease fatigue, Health Assessment Questionnaire (HAQ), and painDETECT score. Multivariate regression analysis demonstrated VAS patient global, VAS pain, and tender points as being independently associated with PSQI. The mixed-effect model revealed no effect of treatment.                  

Conclusion

More PsA patients than PsO patients and HCs reported sleep disturbances. Sleep disturbances were associated with inflammatory and non-inflammatory measures possibly explaining the limited effect of treatment. This demonstrates the need for interdisciplinary approaches to improve the management of sleep disturbance in PsA.

Trial registration: ClinicalTrials.gov (NCT02572700)

Acknowledgements

We wish to acknowledge all patients participating in this study, and data manager Christian Cato Holm, the Parker Institute, for assistance during the collection and retrieval of data to conduct the study.

Disclosure statement

MS has received research funding from Danish Rheumatism Association, the Danish National Psoriasis Foundation, Pfizer, Eli Lilly, Elisabeth and Karl Ejnar Nis-Hanssens Mindelegat, Minister Erna Hamiltons Legat for Videnskab og Kunst, and Overlæge Johan Boserup og Lise Boserups Legat. TSJ has received fees for speaking and/or consultancy from Pfizer, AbbVie, Roche, UCB, Gilead, Biogen, Novartis, and Eli Lilly. AE has received research funding from Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation, and honoraria as a consultant and/or speaker from AbbVie, Almirall, Leo Pharma, Zuellig Pharma, Galápagos, Sun Pharmaceuticals, Samsung Bioepis, Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals. JFM is a consultant and/or investigator for Amgen, Bristol-Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Sun Pharma, Biogen, Pfizer, and Leo Pharma. JGG is an employee and stakeholder of Eli Lilly; his contributions are without influence or responsibility of Eli Lilly. LEK has received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen Pharmaceuticals. The remaining authors have no potential conflicts of interest to report.

Additional information

Funding

Funding has been received from the Elisabeth and Karl Ejnar Nis-Hanssens Mindelegat and Minister Erna Hamiltons Legat for Videnskab og Kunst. The study is further supported by an unrestricted core grant to the Parker Institute from the Oak Foundation (OCAY-18-774-OFIL).