Exploring sleep health and circadian rhythm disruption in Sjögren's disease: an accelerometric and self-reported cross-sectional study.

Abstract

In a cross-sectional study, we aimed at characterizing possible impairments in sleep health and rest-activity parameters between patients with Sjögren's Disease (SjD) and healthy controls (HCs). Furthermore, we explored possible predictors of such disturbances in the SjD group. Participants' sleep and rest-activity rhythms were assessed via 7-day continuous accelerometry, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the reduced Morningness-Eveningness Questionnaire, allowing the creation of a multidimensional sleep health index. Parametric tests explored between-group differences in sleep and rest-activity parameters, while functional linear modelling characterized between-group, time-related differences in accelerometric activity. Within the SjD cohort, regression analysis was employed to explore disease activity, patient-reported disease burden, and the Hospital Anxiety and Depression Scale (HADS) as possible predictors of sleep and rest-activity parameters. Forty-six SjD patients and forty age-, sex- and BMI-matched HCs were included. Compared with HCs, SjD patients reported lower sleep health (P = 0.005) and delayed mid-sleep point (P = 0.009) and acrophase (P = 0.033). Functional linear modelling confirmed the objective shift towards eveningness in SjD patients. In SjD patients, patient-reported disease burden predicted sleep quality (β = 0.41; P = 0.044) and sleepiness (β = 0.83; P = 0.010), while disease activity predicted daily steps (β=-526; P = 0.013), total sleep time (β = 0.15; P = 0.0496) and sleep regularity (β=-1.3; P = 0.030). Finally, HADS predicted daily steps (β = -238; P = 0.041), total sleep time (β = -0.08; P = 0.035) and sleep efficiency (β = -0.65; P = 0.012). SjD is associated with impaired sleep health and rest-activity rhythms. In SjD patients, such alterations differentially associate with disease activity and patient-reported outcomes, supporting a multifactorial model of sleep and circadian rhythms disruption.