J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 6, Number 1, February 2014, pages 44-52

Sleep Quality in Rheumatoid Arthritis: Relationship Between the Disease Severity, Depression, Functional Status and the Quality of Life

**Table 1.** Clinical and Demographic Characteristics of the Patients With RA and Healthy Controls (Mean ± SD)
Disease characteristics	RA patients (n:94)	Controls (n:52)	P
VAS: visual analog scale; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; RF: rheumatoid factor; HAQ: health assesment questionnaire; DAS: disease activity score; BDI: Beck depression inventory; RAQoL: rheumatoid arthritis quality of life; RA: rheumatoid arthritis; n: number of cases; SD: standard deviation.
Age (years)	46.20 ± 12.32	44.07 ± 9.75	NS
Female	81.5%	79.2%	NS
Postmenopausal patient	48%	45%	NS
Disease duration (years)	4.66 ± 5.14
Duration of morning stiffness (minute)	62.99 ± 57.78
Pain (VAS, mm)	5.14 ± 2.65
Fatigue (VAS, mm)	4.68 ± 2.56
ESR (mm/h)	29.18 ± 21.71
CRP (mg/dL)	3.28 ± 6.26
RF (IU/mL)	120.57 ± 176.25
HAQ	1.08 ± 0.87
DAS28	4.17 ± 1.59
Depression (BDI score)	15.56 ± 8.75 (53.3%)
RAQoL	14.05 ± 10.19
Larsen score	30.47 ± 19.70
NSAID	62%
Anti-TNF	48%
DMARD	72%
Corticosteroid	42%

Table 1. Clinical and Demographic Characteristics of the Patients With RA and Healthy Controls (Mean ± SD)

Disease characteristics

RA patients
(n:94)

Controls
(n:52)

VAS: visual analog scale; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; RF: rheumatoid factor; HAQ: health assesment questionnaire; DAS: disease activity score; BDI: Beck depression inventory; RAQoL: rheumatoid arthritis quality of life; RA: rheumatoid arthritis; n: number of cases; SD: standard deviation.

Age (years)

46.20 ± 12.32

44.07 ± 9.75

Female

81.5%

79.2%

Postmenopausal patient

48%

45%

Disease duration (years)

4.66 ± 5.14

Duration of morning stiffness (minute)

62.99 ± 57.78

Pain (VAS, mm)

5.14 ± 2.65

Fatigue (VAS, mm)

4.68 ± 2.56

ESR (mm/h)

29.18 ± 21.71

CRP (mg/dL)

3.28 ± 6.26

RF (IU/mL)

120.57 ± 176.25

HAQ

1.08 ± 0.87

DAS28

4.17 ± 1.59

Depression (BDI score)

15.56 ± 8.75 (53.3%)

RAQoL

14.05 ± 10.19

Larsen score

30.47 ± 19.70

NSAID

62%

Anti-TNF

48%

DMARD

72%

Corticosteroid

42%

**Table 2.** Mean Scores of the RA Patients and Controls for the PSQI Domains (Mean ± SD)
	RA Patients (n:94)	Controls (n:52)	P
SD: standard deviation; PSQI: Pittsburgh sleep quality index; RA: rheumatoid arthritis; n: number of cases.
Subjective sleep quality	1.61 ± 0.86	0.81 ± 0.56	< 0.001
Sleep latency	1.36 ± 0.96	0.77 ± 0.73	< 0.001
Sleep duration	1.14 ± 0.87	1.00 ± 0.65	0.274
Habitual sleep efficiency	0.73 ± 0.99	0.21 ± 0.63	< 0.001
Sleep disturbances	1.24 ± 0.81	1.00 ± 0.56	0.04
Use of sleeping medication	0.10 ± 0.38	0.11 ± 0.42	0.925
Daytime dysfunction	0.80 ± 0.78	0.73 ± 0.69	0.56
PSQI total	7.03 ± 3.97	4.60 ± 2.64	< 0.001

Table 2. Mean Scores of the RA Patients and Controls for the PSQI Domains (Mean ± SD)

RA Patients
(n:94)

Controls
(n:52)

SD: standard deviation; PSQI: Pittsburgh sleep quality index; RA: rheumatoid arthritis; n: number of cases.

Subjective sleep quality

1.61 ± 0.86

0.81 ± 0.56

< 0.001

Sleep latency

1.36 ± 0.96

0.77 ± 0.73

< 0.001

Sleep duration

1.14 ± 0.87

1.00 ± 0.65

0.274

Habitual sleep efficiency

0.73 ± 0.99

0.21 ± 0.63

< 0.001

Sleep disturbances

1.24 ± 0.81

1.00 ± 0.56

0.04

Use of sleeping medication

0.10 ± 0.38

0.11 ± 0.42

0.925

Daytime dysfunction

0.80 ± 0.78

0.73 ± 0.69

0.56

PSQI total

7.03 ± 3.97

4.60 ± 2.64

< 0.001

**Table 3.** Correlation Between the PSQI Scores With Clinical, Radiological, Laboratory and the Psychological Characteristics in Patients With RA
Characteristics	Subjective sleep quality	Sleep latency	Sleep duration	Habitual sleep efficiency	Sleep disturbances	Use of sleeping medication	Daytime dysfunction	PSQI total
VAS: visual analog scale; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; RF: rheumatoid factor; HAQ: health assesment questionnaire; DAS: disease activity score; BDI: Beck depression inventory; RAQoL: rheumatoid arthritis quality of life; PSQI: Pittsburgh sleep quality index; RA: rheumatoid arthritis. P < 0.05, *P < 0.01.
Age	r: 0.110	r: 0.325**	r: 0.255*	r: 0.205	r: 0.382**	r: -0.035	r: 0.311**	r: 0.308**
Disease duration	r: -0.060	r: 0.119	r: 0.012	r: 0.149	r: 0.053	r: 0.138	r: 0.099	r : 0.103
Postmenopausal patients (versus premenopausal)	r: 0.079	r: 0.306**	r: 0.121	r: 0.204	r: 0.381**	r: 0.014	r: 0.162	r: 0.251*
Duration of morning stiffness	r: 0.229*	r: 0.250*	r: 0.139	r: 0.166	r: 0.298**	r: 0.172	r: 0.093	r: 0.218*
Pain ^VAS	r: 0.256*	r: 0.385**	r: 0.305**	r: 0.285**	r: 0.335**	r: 0.072	r: 0.115	r: 0.371**
Fatigue ^VAS	r: 0.249*	r: 0.235*	r: 0.209*	r: 0.351**	r: 0.324**	r: 0.-002	r: 0.319**	r: 0.354**
ESR (mm/h)	r: 0.235*	r: 0.300**	r: 0.124	r: 0.177	r: 0.275**	r: -0.060	r: 0.181	r: 0.263*
CRP (mg/dL)	r: 0.276**	r: 0.256*	r: 0.191	r: 0.189	r: 0.344**	r: 0.000	r: 0.155	r: 0.302**
RF	r: -0.193	r: -0.088	r: -0.043	r: 0.015	r: -0.012	r: 0.004	r: -0.190	r: -0.154
HAQ	r: 0.368**	r: 0.360**	r: 0.301**	r: 0.243**	r: 0.397**	r: 0.063	r: 0.322**	r: 0.431**
DAS28 (Disease activity score)	r: 0.358**	r: 0.369**	r: 0.285**	r: 0.289**	r: 0.405**	r: 0.018	r: 0.113	r: 0.375**
BDI	r: 0.385**	r: 0.361**	r: 0.406**	r: 0.316**	r: 0.373**	r: 0.171	r: 0.299**	r: 0.489**
RAQoL	r: 0.305**	r: 0.331**	r: 0.321**	r: 0.324**	r: 0.379**	r: 0.106	r: 0.283**	r: 0.424**
Larsen score	r: 0.095	r: 0.249*	r: 0.260*	r: 0.323**	r: 0.176	r: 0.090	r: 0.121	r: 0.292**

Table 3. Correlation Between the PSQI Scores With Clinical, Radiological, Laboratory and the Psychological Characteristics in Patients With RA

Characteristics

Subjective sleep quality

Sleep latency

Sleep duration

Habitual sleep efficiency

Sleep disturbances

Use of sleeping medication

Daytime dysfunction

PSQI total

VAS: visual analog scale; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; RF: rheumatoid factor; HAQ: health assesment questionnaire; DAS: disease activity score; BDI: Beck depression inventory; RAQoL: rheumatoid arthritis quality of life; PSQI: Pittsburgh sleep quality index; RA: rheumatoid arthritis. *P < 0.05, **P < 0.01.

Age

r: 0.110

r: 0.325**

r: 0.255*

r: 0.205

r: 0.382**

r: -0.035

r: 0.311**

r: 0.308**

Disease duration

r: -0.060

r: 0.119

r: 0.012

r: 0.149

r: 0.053

r: 0.138

r: 0.099

r : 0.103

Postmenopausal patients (versus premenopausal)

r: 0.079

r: 0.306**

r: 0.121

r: 0.204

r: 0.381**

r: 0.014

r: 0.162

r: 0.251*

Duration of morning stiffness

r: 0.229*

r: 0.250*

r: 0.139

r: 0.166

r: 0.298**

r: 0.172

r: 0.093

r: 0.218*

Pain ^VAS

r: 0.256*

r: 0.385**

r: 0.305**

r: 0.285**

r: 0.335**

r: 0.072

r: 0.115

r: 0.371**

Fatigue ^VAS

r: 0.249*

r: 0.235*

r: 0.209*

r: 0.351**

r: 0.324**

r: 0.-002

r: 0.319**

r: 0.354**

ESR (mm/h)

r: 0.235*

r: 0.300**

r: 0.124

r: 0.177

r: 0.275**

r: -0.060

r: 0.181

r: 0.263*

CRP (mg/dL)

r: 0.276**

r: 0.256*

r: 0.191

r: 0.189

r: 0.344**

r: 0.000

r: 0.155

r: 0.302**

r: -0.193

r: -0.088

r: -0.043

r: 0.015

r: -0.012

r: 0.004

r: -0.190

r: -0.154

HAQ

r: 0.368**

r: 0.360**

r: 0.301**

r: 0.243**

r: 0.397**

r: 0.063

r: 0.322**

r: 0.431**

DAS28 (Disease activity score)

r: 0.358**

r: 0.369**

r: 0.285**

r: 0.289**

r: 0.405**

r: 0.018

r: 0.113

r: 0.375**

BDI

r: 0.385**

r: 0.361**

r: 0.406**

r: 0.316**

r: 0.373**

r: 0.171

r: 0.299**

r: 0.489**

RAQoL

r: 0.305**

r: 0.331**

r: 0.321**

r: 0.324**

r: 0.379**

r: 0.106

r: 0.283**

r: 0.424**

Larsen score

r: 0.095

r: 0.249*

r: 0.260*

r: 0.323**

r: 0.176

r: 0.090

r: 0.121

r: 0.292**

**Table 4.** Final Logistic Regression Model; PSQI Total Score as Dependent Variable (PSQI ≥ 6 Versus PSQI < 6)
	B	SE	Wald	P	OR	95% CI for OR
DAS: disease activity score; BDI: Beck depression inventory; B: coefficients; SE: standard error; OR: odds ratio; CI: confidence interval.
BDI	-0.124	0.044	8.071	0.004	1.132	1.039	1.234
DAS28	-0.706	0.207	11.65	0.001	2.024	1.351	3.039
Constant	3.957	0.965	16.798	0.000	0.019

Table 4. Final Logistic Regression Model; PSQI Total Score as Dependent Variable (PSQI ≥ 6 Versus PSQI < 6)

Wald

95% CI for OR

Lower

Upper

DAS: disease activity score; BDI: Beck depression inventory; B: coefficients; SE: standard error; OR: odds ratio; CI: confidence interval.

BDI

-0.124

0.044

8.071

0.004

1.132

1.039

1.234

DAS28

-0.706

0.207

11.65

0.001

2.024

1.351

3.039

Constant

3.957

0.965

16.798

0.000

0.019