Association between depression and sleep quality in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Abstract

Background Currently, there is no consistent understanding of the relationship between depression and sleep quality in patients with systemic lupus erythematosus (SLE). This study aimed to explore the correlation between depression and sleep quality in SLE patients. Methods Five English (PubMed, Web of Science, EMBASE, Cochrane Library, and CINAHL) databases were systematically searched from inception to January 12, 2021. Two authors independently screened publications and extracted data according to set inclusion and exclusion criteria. Statistical analyses were performed with STATA 16.0. Data were pooled using a random-effects model. Results A total of 9 identified studies matched the inclusion criteria, reporting on 514 patients with SLE in the analysis. A moderate correlation of depression with sleep quality was found (pooled r = 0.580 [0.473, 0.670]). Compared to good sleepers, patients with SLE and poor sleep quality had higher levels of depression (standardized mean difference = − 1.28 [− 1.87, − 0.69]). Depression was associated with subjective sleep quality (r = 0.332 [0.009, 0.592]), sleep latency (r = 0.412 [0.101, 0.649]), sleep disturbances (r = 0.405 [0.094, 0.645]), daytime dysfunction (r = 0.503 [0.214, 0.711]), the four dimensions of Pittsburgh Sleep Quality Index (PSQI), while no significant correlation was found in the other three PSQI dimensions. Conclusion Depression had a moderate correlation with sleep quality in patients with SLE. Patients with poor sleep quality tended to have higher level of depression than that of good sleepers. Awareness of the correlation may help rheumatology physicians and nurses to assess and prevent depression and improve sleep quality in patients with SLE.

Association between rheumatoid arthritis and thyroid dysfunction: A meta-analysis and systematic review

“…Because the clinical manifestations of thyroid disease are highly variable and usually nonspecific, the diagnosis of thyroid dysfunction relies primarily on laboratory biochemical tests (49). Although many studies have assessed the risk of thyroid dysfunction in patients with RA, their conclusions have been inconsistent, perhaps due to differences in the populations and geographical regions across studies (51). For example, Nazary et al compared thyroid function in 400 newly diagnosed RA patients with matched controls and found a higher prevalence of thyroid dysfunction in RA patients (25.25% vs. 11.5%; P value = 0.00001).…”

“…The underlying mechanisms of thyroid dysfunction in patients with RA are unclear ( 51 ). Thyroid dysfunction often occurs in autoimmune thyroid disease (AITD), particularly in Hashimoto’s thyroiditis and Graves’s disease.…”

Association of Sleep Deprivation and the Risk of Developing Systemic Lupus Erythematosus Among Women

“…Perhaps then, these overlapping pathways may explain why depression and pain may act synergistically with sleep deprivation to accentuate SLE risk, as in our study. Indeed, in established SLE, these disorders are commonly reported by patients and are correlated with one another (30,31). Therefore, a better understanding of these mechanisms will not only enable us to identify effective therapeutic and prevention strategies for these disorders, but also the subsequent risk of autoimmune disease development.…”

Subjective sleep quality and fatigue assessment in Polish adult patients with primary immunodeficiencies: A pilot study

“…They revealed that the vast majority of patients with RA have poor sleep quality, which may be associated with disease activity and ongoing inflammation (39). Likewise, patients with SLE report sleep disorders as frequent complaints with poorer sleep quality compared to the general population (40). Alterations in the immune system owing to sleep impairment may affect the course of autoimmune diseases.…”