Effect of anti-TNF treatment on sleep problems in ankylosing spondylitis

Abstract

Sleep disturbances and problems are increased in ankylosing spondylitis (AS). But much is not known in a quantitative way about sleep problems and effect of treatments on AS. This study is aimed first, to investigate sleep disturbances in AS and secondly, to evaluate the effects of anti-TNF treatment on SD in AS. One hundred seventy-one (Female/male: 90/81) AS patients fulfilling modified New York criteria and 86 (F/M: 56/30) age- and gender-matched controls without inflammatory diseases were included into the study. Demographic data and disease activity and treatments were recorded using The Bath Ankylosing Spondylitis Functional Index (BASFI) and The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The Medical Outcomes Study (MOS) Sleep Questionnaire was used for evaluating sleep and problems of sleep. AS patients had higher sleep disturbance scale (SDS) and sleep problem index (SPI) II scores. Group A (patients using NSAID and/or DMARD, 53.2% of patients) had higher BASDAI and BASFI compared with Group B (Patients using anti-TNF treatments) (4.29 ± 2.38 vs. 2.46 ± 2.32, p < 0.001; 1.95 ± 2.15 vs. 0.93 ± 1.31, p < 0.001, respectively). Whereas Group A had higher scores of SDS, awaken short of breath or headache, somnolence, and SPI-II than controls, none of the sleep parameters were statistically different between patients on anti-TNF treatments and controls. BASDAI was positively correlated with SPI-I, SPI-II, SDS, and somnolence scale. AS patients had increased sleep problems and disturbances compared with controls. Anti-TNF agents improve significantly these problems. Sleep problems are significantly correlated with the disease activity.

Prevalence and factors associated with disturbed sleep in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review

“…Gender differences were either not found [ 23 ] or not reported [ 21,25,30,32 ] in other descriptive studies within this review. In addition, some larger sample studies not included in this review do not support a marked gender difference in sleep disruption for AS populations [ 16,17 ].…”

“…Despite this striking association, only 2 of 4 papers that investigating correlations between total sleep scores and (CRP/ESR) inflammatory blood markers [ 23,25,30,32 ] reported significant correlations [ 23,32 ] and in only one study was the effect size classified as medium strength. This may be due to the questionable validity of ESR/CRP to accurately reflect disease activity within this population [ 52 ].…”

“…Five studies directly compared overall sleep scores in a healthy control group with those in an AS group [ 21,23,25,30,32 ]. All of these studies found significant differences between AS patients and the control subjects.…”

Restless legs syndrome is associated with poor sleep quality and quality of life in patients with ankylosing spondylitis: a questionnaire-based study

“…Sleep disturbance, which includes problems associated with getting to and maintaining sleep, relates to the severity of RLS [6]. Several studies evaluated sleep quality in AS patients [33][34][35][36] but none of them investigated the relationship with RLS. Hultgren et al [33] reported that the pain was the main reason of sleep disturbances in patients with AS.…”

Sleep quality, sleeping postures, and sleeping equipmentin patients with ankylosing spondylitis

“…Sleep disorders are commonly observed in AS, including impaired quality of sleep, sleep-onset insomnia, difficulty in waking up, and obstructive sleep apnea (OSA) syndrome (5,(8)(9)(10)(11)(12). However, antitumor necrosis factor (anti-TNF) treatment has been shown to improve sleep disorders related to AS (13).…”