Objective and subjective sleep assessment in systemic lupus erythematosus and association with disease characteristics and quality of life.

Abstract

Sleep disturbances significantly impact quality of life (QoL) in systemic lupus erythematosus (SLE). This study aimed to assess sleep quality in cases and controls using both subjective and objective measures and explore association with disease characteristics, psychological factors, physical function and QoL. Ninety cases and 90 matched healthy controls were enrolled in this prospective study. Subjective sleep assessment utilized the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Objective sleep assessment used the Withings Sleep Analyzer (WSA). Disease activity, cumulative damage, functional impairment, psychological health and QoL were assessed using validated questionnaires. The mean age of cases was 37.11 (13.01) years, with 90% females. Disease duration averaged 7.12 (6.65) years, with a mean disease activity (SLEDAI-2K) of 4.01 (3.72) and cumulative damage (SLICC-DI) of 0.40 (0.76). Poor sleep (PSQI > 4) was reported in 82.2% of SLE cases [mean 7.59 (3.33)] vs 46.7% of controls [mean 4.52 (2.90), P < 0.01]. WSA assessments (35 SLE cases and 50 controls) showed poor sleep (WSA score ≤ 65) in 77.1% of SLE patients, compared with 10% of controls (P < 0.01). Logistic regression showed that higher PSQI scores were associated with ESS (P < 0.01) and physical domain of WHO-QoL (P < 0.01). WSA scores also correlated with the physical domain of WHO-QoL (P = 0.02). SLE profoundly impacts all domains of life. Worse sleep quality was reported in SLE patients by both subjective and objective measures. Objective measures of sleep assessment like WSA can help provide measurable outcomes in chronic diseases with a possible role in research, diagnosis, monitoring and follow-up.