Assessment of sleep health in patients with rheumatic disease

Poor sleep is a common complaint of patients attending rheumatology clinics and has been observed to frequently accompany symptoms of depression, fatigue, pain and increased rheumatic disease activity [1–3]. In the past, sleep difficulties had been understood and/or perhaps dismissed as expected sequelae of the articular pain and discomfort in this patient population. More recently, there has been recognition of a more complex and intertwined relationship between rheumatic diseases and sleep disorders. Abnormal sleep has been reported in a number of rheumatologic disorders with the majority of observations based upon the rheumatoid arthritis (RA) patient and fibromyalgia populations [4,5]. However, sleep abnormalities or dysfunction have also been identified in juvenile rheumatoid arthritis [6], Sjögren’s syndrome [7], systemic lupus erythematosus (SLE) [8], scleroderma [9], spondyloarthropathy [10,11], osteoarthritis [12], gout [13] and sarcoidosis patients [14]. The nature of sleep disturbances or abnormalities in rheumatic disease patients varies from clinically recognized distinct sleep disorders to a spectrum of difficulty with sleep initiation and fragmentation, or ‘insomnia’ symptomatology [4]. An increase in primary sleep disorders, specifically obstructive sleep apnea (OSA) and restless legs syndrome (RLS), has been reported in RA patients [15–18]. In addition, subjective symptoms of poor sleep quality, self-reported sleep fragmentation and prolonged sleep initiation are common in patients with RA, SLE, spondyloarthropathies and fibromyalgia [2,4,11,19,20]. Distinguishing a primary sleep disorder from a more nonspecific poor sleep quality symptomatology is clinically important. An accurate understanding of the nature of the sleep disorders permits appropriate choice of a therapeutic program.