Improved sleep efficiency after anti-tumor necrosis factor α therapy in rheumatoid arthritis patients

Abstract

Abstract:Background: Poor sleep health is increasingly recognized as contributing to decreased quality of life, increased morbidity/mortality and heightened pain perception. Our purpose in this study was to observe the effect on sleep parameters, specifically sleep efficiency, in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor alpha (anti-TNF-a) therapy. Methods: This was a prospective observational study of RA patients with hypersomnolence/ poor sleep quality as defined by the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Study patients underwent overnight polysomnograms and completed questionnaire instruments assessing sleep prior to starting anti-TNF-a therapy and again after being established on therapy. The questionnaire included the ESS, PSQI, the Berlin instrument for assessment of obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS) diagnostic criteria, and measures of disease activity/impact. Results: A total of 12 RA patients met inclusion criteria, of which 10 initiated anti-TNF-a therapy and underwent repeat polysomnograms and questionnaire studies approximately 2 months later. Polysomnographic criteria for OSA were met by 60% of patients. Following anti-TNF-a therapy initiation, significant improvements were observed by polysomnography (PSG) for sleep efficiency, increasing from 73.9% (SD 13.5) to 85.4% (SD 9.6) (p ¼ 0.031), and 'awakening after sleep onset' time, decreasing from 84.1 minutes (SD 43.2) to 50.7 minutes (SD 36.5) (p ¼ 0.048). Questionnaire instrument improvements were apparent in pain, fatigue, modified Health Assessment Questionnaire (mHAQ), and Rheumatoid Arthritis Disease Activity Index (RADAI) scores. Conclusions: Improved sleep efficiency and 'awakening after sleep onset' time were observed in RA patients treated with anti-TNF-a therapy.

Severity of the Apnea-Hypopnea Sleep Syndrome in Patients with Rheumatoid Arthritis and Spondyloarthropathies. Modulation of the Sleep Apnea Index with Anti-TNF-? Inhibitors

“…In this work, greater severity of the SAHS is observed in patients with inflammatory arthritis as well as its improvement, evaluated through the AHI, with treatment with anti-TNF-α. This corroborates some preliminary observation [12] and the importance that these drugs may have as modulators of the common etiopathogenic nexus of inflammatory arthritides with associated SAHS.…”

“…Thus, when SAHS is treated with continuing positive air pressure, a reduction is observed in blood pressure, triglycerides and glycated hemoglobin [11]. Furthermore, it has been stated that treatment with anti-TNF-α in patients with RA and sleep disorders improves sleep quality [12]. However, at present, there are still few studies that evaluate the severity of SAHS in patients with RA or SpA, the increase of CV risk that this association implies and the possible modulation of the nighttime anoxia-hypoxia episodes with treatment with anti TNF-α drugs.…”

Anti-Citrullinated Cyclic Peptide Antibody and Functional Disability Are Associated With Poor Sleep Quality in Rheumatoid Arthritis

“…3,30 The study by Taylor-Gjevre et al 31 demonstrated improved sleep efficiency and "awakening after sleep onset" time observed by polysomnography in RA patients treated with anti-tumor necrosis factor-alpha therapy. However, the mean PSQI scores increased (10.4 to 10.8) with the therapy despite significant reduction in the disease activity (p=0.048).…”

Obstructive sleep apnea, hypoxia and inflammatory arthritis: how may they be linked?

“…This TNF-α (-308) allele has been described as significantly associated with a diagnosis of OSA compared with population controls [17]. Anti-TNF-α biologic strategies have been reported to have some efficacy in treatment of OSA patients (without concurrent rheumatic disease) and also on some polysomnographic sleep parameters in RA patients [18,19]. A lower incidence of OSA in ankylosing spondylitis patients on anti-TNF-α therapies has been observed [20].…”