POS0992 PREVALENCE AND ASSOCIATED FACTORS OF SLEEP DISORDERS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE SPANISH ATLAS
Authors: M. Garrido-Cumbrera, V. Navarro-Compán, E. Collantes-Estevez, P. Zarco-Montejo, S. Sanz-Gómez, C. Sastré, P. Plazuelo-Ramos, J. Gratacos-Masmitja
Journal: Annals of the Rheumatic Diseases (2021)

Background: Sleep is an essential aspect of health that is commonly disrupted in patients with axial spondyloarthritis (axSpA). Objectives: This analysis aims to assess the prevalence and associated factors of sleep disorders in a large sample of axSpA patients. Methods: In 2016, a sample of 680 unselected patients with axSpA participated in the Atlas of Axial Spondyloarthritis in Spain through an online survey. The sample was divided into: 1) Patients with sleep disorders and 2) Patients without sleep disorders. Disease activity through BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54) and, mental health through a 12-item General Health Questionnaire GHQ-12 (0-12) were assessed. The Mann-Whitney and Pearson’s chi-square tests were used to analyse possible relationships between independent sociodemographic characteristics, employment, lifestyle, patient-reported outcomes and comorbidity variables with sleep disorders. Univariate and multivariate binary logistic regression was used to determine the possible association of the independent variables on sleep disorders. Results: Mean age was 45.7 years, 52.5% female, 36.9% had a university degree, and 71.5% were married. The prevalence of sleep disorders was 19.7%. Those who reported sleep disorders presented higher disease activity (6.3 vs 5.4, p&lt;0.001), worse mental health (7.7 vs 5.0, p&lt;0.001), greater functional limitation (45.7 vs 41.4, p&lt;0.001), greater spinal stiffness (8.0 vs 7.3, p=0.008), and longer diagnostic delay (10.5 vs 7.9, p=0.021). 29.9% of the patients on sick leave had sleep disorders, compared to only 15.4% of employees (p=0.013). In addition, 23.0% of those who were physically active had sleep disorders compared to only 7.1% of those not physically active (p&lt;0.001). Sleep disorders were more prevalent in patients with other comorbidities such as anxiety (60.0% vs 9.7%, w/o anxiety, p&lt;0.001) and depression (66.0% vs 11.7% w/o depression, p&lt;0.001). In the multivariate binary logistic regression, depression (OR= 3.89), anxiety (OR= 3.84), and a longer diagnostic delay (B=0.034) remained significantly associated with sleep disorders. Excluding mental comorbidity parameters from the model, physical activity (OR= 3.52) and disease activity (B= 0.175) remained significantly associated with sleep disorders (Table 1). Table 1. Logistic regression to analyses factor associated with sleep disorders (N= 366) Univariate logistic analysis Multivariate logistic analysis Multivariate logistic analysis* OR p-value 1 OR p-value 1 OR p-value 1 Qualitative factors Employment. Sick leave 1.937 0.003 1.554 0.180 1.540 0.131 Physical activity. Yes 3.914 &lt;0.001 2.410 0.196 3.516 0.048 Anxiety diagnosis 13.925 &lt;0.001 3.840 &lt;0.001 -- -- Depression diagnosis 14.616 &lt;0.001 3.886 &lt;0.001 -- -- Quantitative factors B p-value 2 B p-value 2 B p-value 2 BASDAI (0-10) 0.238 &lt;0.001 0.036 0.673 0.175 0.015 GHQ-12 0.141 &lt;0.001 0.045 0.204 -- -- Functional Limitation (0-54) 0.049 &lt;0.001 -0.011 0.560 0.022 0.166 Spinal Stiffness (3-12) 0.104 0.008 0.016 0.775 0.020 0.683 Diagnostic Delay 0.041 0.001 0.034 0.044 0.025 0.083 *Excluding mental health factors. 1 p-value for test H 0 : OR = 1 2 p-value for test H 0 : B = 0 Conclusion: One of five patients with axSpA reported sleep disorders. The presence of mental comorbidities such as anxiety and depression increases the likelihood of sleep disorders. Moreover, physical activity and disease activity also seem to increase the probability on sleep disorders. Referral to mental health specialists together with optimal healthcare management should be key for the reduction of sleep disorders in axSpA. Acknowledgements: This study was supported by Novartis Spain. The authors would like to thank all patients who participated in this study. Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Eduardo Collantes-Estevez Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Pedro Zarco-Montejo: None declared, Sergio Sanz-Gómez: None declared, Carlos Sastré Employee of: Novartis Farmacéutica Spain, Pedro Plazuelo-Ramos: None declared, Jordi Gratacos-Masmitja Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.