Sleep problems pester patients with psoriatic arthritis

Patients with psoriatic arthritis (PsA) often struggle with poor sleep quality, results of a systematic review and meta-analysis have shown.

A team of investigators identified 36 eligible studies, including 26 cross-sectional, seven cohort, and three interventional studies, from the databases of PubMed and Embase.

Self-reported sleep problems in PsA patients had a prevalence ranging from 30 percent to 85 percent. In a meta-analysis of six studies using the Pittsburgh Sleep Quality Index, patients with PsA had a 72.9-percent (95 percent confidence interval [CI], 63‒81.8; I², 78 percent) prevalence of poor sleep quality.

Such rate was statistically greater than that seen in healthy controls (26.9 percent, 95 percent CI, 11.7‒45.4; I², 81 percent) but not statistically different from that in patients with psoriasis (59.8 percent, 95 percent CI, 46.9‒72.1; I², 51 percent).

“Sleep disturbance was ranked in the top 4 health-related quality of life domains affected by PsA,” the investigators said. “One study suggested a bidirectional relationship between PsA and obstructive sleep apnoea.”

Sleep problems were significantly associated with anxiety, pain, erythrocyte sedimentation rate, depression fatigue, physical function, and tender or swollen joint count. On the other hand, tumour necrosis factor inhibitors, guselkumab, and filgotinib (a Janus kinase inhibitor) all contributed to improved sleep outcomes.

“Objective sleep measures (ie, actigraphy and polysomnography) have not been used in PsA studies, and evidence on the validity of patient-reported sleep measures in PsA is lacking,” the investigators noted.

“Future studies should validate self-reported sleep measures in PsA, explore how sleep quality relates to PsA disease activity and symptoms using both objective and subjective sleep measures, assess the efficacy of strategies to manage sleep problems, and assess the effects of such management on symptoms and disease signs in patients with PsA,” they said.