Factors That Influence Sleep Disturbance and the Mediating Effects of Depression on Sleep Disturbance in Patients With Rheumatoid Arthritis

Abstract

Little is known about the nature of relationships between sleep disturbance and influencing factors in rheumatoid arthritis. The purpose of this study was to identify factors that influence sleep disturbance and to evaluate mediating effects of depression on sleep disturbance. A nonexperimental, descriptive, correlational study design was adopted. One hundred patients with rheumatoid arthritis were recruited. Inflammatory status and levels of pain, fatigue, functional disability, depression, and sleep disturbance were measured. The factors that directly influenced sleep disturbance were gender, rheumatoid arthritis duration, serum C-reactive protein level, fatigue, and depression. Depression was found to have mediating effects on the relationships between sleep disturbance and arthritis symptoms. Pain, fatigue, and depression were found to have significant direct or indirect impacts on sleep disturbance. Our findings may improve understanding of sleep disturbance and aid the development of effective nursing management strategies for patients with rheumatoid arthritis suffering from sleep disturbance.

A concept elicitation study to understand the relationship between sleep and pain in rheumatoid arthritis and axial spondyloarthritis

“…However, despite evidence regarding the presence of this relationship, the direction of causality and mechanisms involved are not clear [ 32 ]; while joint (RA) and back (axSpA) pain can disrupt sleep, studies in both conditions have demonstrated a reverse relationship, where disturbances in sleep can also aggravate pain [ 23 , 31 , 33 ]. In addition, other disease-related factors of RA and axSpA, independent of pain (such as fatigue, depression, anxiety, stress, and inflammatory markers), have also been associated with sleep disturbance [ 24 , 31 , 34 – 37 ].…”