Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögren’s syndrome

a cross-sectional study

Authors

Keywords:

Sleep wake disorders, Fatigue, Sjogren’s syndrome

Abstract

BACKGROUND: Fatigue is a frequent symptom in patients with primary Sjögren’s syndrome (pSS) and can be a cause of or be associated with sleep disorders. OBJECTIVE: To assess the sleep quality of pSS patients and its relationship with fatigue and disease activity. DESIGN AND SETTING: Analytical observational study conducted at an exercise psychobiology laboratory. METHODS: Sleep quality was evaluated using the Pittsburg sleep quality index (PSQI) and actigraphy. Fatigue was evaluated through the Profile of Fatigue and Discomfort – Sicca Symptoms Inventory (PROFAD-SSI-SF) and a visual analogue scale for fatigue (VAS-fatigue). Disease activity was evaluated using a visual analogue scale for pain (VAS-pain), EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) and Disease Activity Index (ESSDAI). We summarized the data through descriptive statistics. RESULTS: A total of 50 female patients with pSS, of average age 56.4 years, were included in the study; 80% presented low disease activity. The total PSQI score showed that 74% had poor sleep. The actigraphy showed mean sleep latency of 26.2 minutes and mean nightly awakening of 48.2 minutes (duration of wakings after sleep onset, WASO). There were correlations between PSQI and VAS-pain, VAS-fatigue, PROFAD-SSI and ESSPRI. Actigraphy showed a correlation between the duration of WASO and ESSDAI. CONCLUSION: The present study provides important information regarding correlations between sleep disorders and disease activity. There is a need for proper control over disease activity and for development of strategies to help patients to sleep better in order to diminish their fatigue. CLINICAL TRIAL REGISTRATION: NCT03130062.

Downloads

Download data is not yet available.

Author Biographies

Luciana Paula Dardin, Universidade Federal de São Paulo

PT. Physiotherapist and Doctoral Student, Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.

Ana Beatriz Andreo Garcia, Universidade Federal de São Paulo

MD. Physician, Department of Ophthalmology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.

Fernanda Martins Gazoni, Universidade Federal de São Paulo

MD. Physician, Discipline of Geriatrics and Gerontology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; and Doctoral Student, Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.

Fania Cristina dos Santos, Universidade Federal de São Paulo

MD, PhD. Professor, Discipline of Geriatrics and Gerontology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.

Marco Tulio de Mello, Universidade Federal de São Paulo

PhD. Professor, Physical Education School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.

Virginia Fernandes Moça Trevisani, Universidade Federal de São Paulo

MD, PhD. Professor, Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; and Professor, Discipline of Rheumatology, Universidade Santo Amaro (UNISA), São Paulo (SP), Brazil.

References

Mavragani CP, Moutsopoulos HM. Sjögren syndrome. CMAJ. 2014;186(15):E579-86. PMID: 24566651; doi: 10.1503/cmaj.122037.

Fox RI. Sjogren’s syndrome. Lancet. 2005 Jul; 366(9482):321-31. PMID: 16039337; doi: 10.1016/S0140-6736(05)66990-5.

Peters JE, Isenberg DA. Sjogren’s syndrome and association with other autoimmune and rheumatic diseases In: MR Casals, JH Stone, HM Moutsopoulos, editors. Sjögren’s Syndrome: Diagnosis and Therapeutics. Springer. 2012;455-76. doi: 10.1007/978-0-85729-947-5.

Rehman H. Sjögren’s syndrome. Yonsei Med J. 2003;44(6):947-54. PMID: 14703600; doi: 10.3349/ymj.2003.44.6.947.

Haldorsen K, Bjelland I, Bolstad AI, Jonsson R, Brun JG. A five-year prospective study of fatigue in primary Sjögren’s syndrome. Arthritis Res Ther. 2011;13(5):R167. PMID: 21996338; doi: 10.1186/ar3487.

Theander L, Strömbeck B, Mandi T, Theander E. Sleepiness or fatigue? Can we detect treatable causes of tiredness in primary Sjögren’s syndrome? Rheumatology (Oxford). 2010;49(6):1177-83. PMID: 20308122; doi: 10.1093/rheumatology/keq023.

Giles I, Isenberg D. Fatigue in primary Sjögren’s syndrome: is there a link with the fibromyalgia syndrome? Ann Rheum Dis. 2000;59(11):875-8. PMID: 11053064; doi: 10.1136/ard.59.11.875.

d’Elia HF, Rehnberg E, Kvist G, et al. Fatigue and blood pressure in primary Sjogren’s syndrome. Scand J Rheumatol. 2008;37(4):284-92. PMID: 18612929; doi: 10.1080/03009740801907995.

Strömbeck BE, Theander E, Jacobsson LT. Effects of exercise on aerobic capacity and fatigue in women with primary Sjögren’s Syndrome. Rheumatology (Oxford). 2007;46(5):868-71. PMID: 17308315; doi: 10.1093/rheumatology/kem004.

Barendregt PJ, Visser MR, Smets EM, et al. Fatigue in primary Sjögren’s syndrome. Ann Rheum Dis. 1998;57(5):291-5. PMID: 9741313; doi: 10.1136/ard.57.5.291.

Mandl T, Hammar O, Theander E, Wollmer P, Ohlsson B. Autonomic nervous dysfunction development in patients with primary Sjögren’s syndrome: a follow-up study. Rheumatology (Oxford). 2010;49(6):1101-6. PMID: 20219783; doi: 10.1093/rheumatology/keq042.

Abad VC, Sarinas PS, Guilleminault C. Sleep and rheumatologic disorders. Sleep Med Rev. 2008;12(3):211-28. PMID: 18486034; doi: 10.1016/j.smrv.2007.09.001.

Ng WF, Bowman SJ. Primary Sjögren’s syndrome: too dry and too tired. Rheumatology (Oxford). 2010;49(5):844-53. PMID: 20147445; doi: 10.1093/rheumatology/keq009.

Hartkamp A, Geenen R, Bijl M, et al. Serum cytokine levels related to multiple dimensions of fatigue in patients with primary Sjögren’s syndrome. Ann Rheum Dis. 2004;63(10):1335-7. PMID: 15361396; doi: 10.1136/ard.2003.011825.

Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487-504. PMID: 18853708.

Ancoli-Israel S, Cole R, Alessi C, et al. The role of actigraphy in the study of sleep and circadian rhythms. Sleep. 2003;26(3):342-92. PMID: 12749557; doi: 10.1093/sleep/26.3.342.

Morgenthaler T, Alessi C, Friedman L, et al. Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep. 2007;30(4):519-29. PMID: 17520797; doi: 10.1093/sleep/30.4.519.

Matuzaki L, Santos-Silva R, Marqueze EC, et al. Temporal sleep patterns in adults using actigraph. Sleep Sci. 2014;7(3):152-7. PMID: 26483920; doi: 10.1016/j.slsci.2014.09.012.

Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61(6):554-8. PMID: 12006334; doi: 10.1136/ard.61.6.554.

Seror R, Ravaud P, Mariette X, Bootsma H, Theander E, Hansen A, et al. EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI): development of a consensus patient index for primary Sjögren’s syndrome. Ann Rheum Dis. 2011;70(6):968-72. PMID: 21345815; doi: 10.1136/ard.2010.143743.

Seror R, Theander E, Brun JG, et al. Validation of EULAR primary Sjogren’s syndrome disease activity (ESSDAI) and patient indexes (ESSPRI). Ann Rheum Dis. 2015;74(5):859-66. PMID: 24442883; doi: 10.1136/annrheumdis-2013-204615.

Bowman SJ, Booth DA, Platts RG; UK Sjögren’s interest group. Measurement of fatigue and discomfort in primary Sjögren’s syndrome using a new questionnaire tool. Rheumatology (Oxford). 2004;43(6):758-64. PMID: 15039495; doi: 10.1093/rheumatology/keh170.

Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56. PMID: 6226917.

Strömbeck B, Theander E, Jacobsson LT. Assessment of fatigue in primary Sjögren’s syndrome: the Swedish version of the Profile of fatigue. Scand J Rheumatol. 2005;34(6):455-9. PMID: 16393768; doi: 10.1080/03009740510026571.

Bertolazi AN, Fagondes SC, Hoff LS, et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011;12(1):70-5. PMID: 21145786; doi: 10.1016/j.sleep.2010.04.020.

Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83. PMID: 1593914.

Akoglu H. User’s guide to correlation coefficients. Turk J Emerg Med. 2018;18(3):91-3. PMID: 30191186; doi: 10.1016/j.tjem.2018.08.001.

Segal B, Thomas W, Rogers T, et al. Prevalence, severity and predictors of fatigue in primary Sjogren’s syndrome. Arthritis Rheum. 2008;59(12):1780-7. PMID: 19035421; doi: 10.1002/art.24311.

Godaert GL, Hartkamp A, Geenen R, et al. Fatigue in daily life in patients with primary Sjogren’s syndrome and systemic lupus erythematous. Ann N Y Acad Sci. 2002;966:320-6. PMID: 12114289; doi: 10.1111/j.1749-6632.2002.tb04232.x.

Meijer JM, Meiners PM, Huddleston Slater JJ, et al. Health-related quality of life, employment and disability in patients with Sjogren’s syndrome. Rheumatology (Oxford). 2009;48(9):1077-82. PMID: 19553376; doi: 10.1093/rheumatology/kep141.

Segal B, Bowman SJ , Fox PC, et al. Primary Sjögren’s Syndrome: health experiences and predictors of health quality among patients in the United States. Health Qual Life Outcomes. 2009;7:46. PMID: 19473510; doi: 10.1186/1477-7525-7-46.

Callaghan R, Prabu A, Allan RB, et al. Direct healthcare costs and predictors of costs in patients with primary Sjogren’s syndrome. Rheumatology (Oxford). 2007;46(1):105-11. PMID: 16728437; doi: 10.1093/rheumatology/kel155.

Westhoff G, Dorner T, Zink A. Fatigue and depression predict physician visits and work disability in women with primary Sjogren’s syndrome: results from a cohort study. Rheumatology (Oxford). 2012;51(2):262-9. PMID: 21705778; doi: 10.1093/rheumatology/ker208.

Gudbjornsson B, Broman JE, Hetta J, Hällgren R. Sleep disturbances in patients with primary Sjogren’s Syndrome. Br J Rheumatol. 1993;32(12):1072-6. PMID 8252317.

Downloads

Published

2020-03-02

How to Cite

1.
Dardin LP, Garcia ABA, Gazoni FM, Santos FC dos, Mello MT de, Trevisani VFM. Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögren’s syndrome: a cross-sectional study. Sao Paulo Med J [Internet]. 2020 Mar. 2 [cited 2025 Mar. 9];138(2):146-51. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/595

Issue

Vol. 138 No. 2 (2020)

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.