POS0961 PREVALENCE AND ASSOCIATED FACTORS OF SLEEP DISORDERS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)
Authors: M. Garrido-Cumbrera, V. Navarro-Compán, L. Christen, C. Bundy, R. Mahapatra, S. Makri, C. J. Delgado-Domínguez, J. Correa-Fernández, D. Poddubnyy
Journal: Annals of the Rheumatic Diseases (2021)

Background: Sleep is an essential health aspect that is often impacted 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 European axSpA patients. Methods: Data were analyzed from 2,846 unselected patients with self-reported clinician-given diagnosis of axSpA of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries. Socio-demographic data; BASDAI [0-10] scores; engagement in physical activity; axSpA influence on work choice (assessed with yes/no question “Was your current or past work choice in any way determined by axSpA?”); risk of psychological distress (12-item General Health Questionnaire [GHQ-12; 0-12]); functional limitation [0-54] and self-reported anxiety and depression were evaluated. Presence of sleep disorders was assessed by the question: “Please indicate whether you have been diagnosed with any of the following: sleep disorders”. A Mann-Whitney test was used to compare the means of numerical variables between dichotomous variables, the Chi-Square test was used to compare the distribution between the categorical variables. Simple and multivariable logistic regression models were used to identify associations between sleep disorders and disease characteristics, mental health and work-related variables. Results: Age of respondents was 43.9 years; 61.3% were female; 48.1% had a university degree; 67.9% were married and 71.3% were HLA-B27 positive. The prevalence of sleep disorders was 39.0%. In the bivariate analysis, presence of sleep disorders was associated with female gender (68.3% vs. 31.7%; p&lt;0.001); overweight/obese (56.5% vs. 49.8%; p&lt;0.001); increased BASDAI scores (6.1±1.8 vs. 5.0±2.1; p&lt;0.001); fatigue (7.0±2.0 vs. 5.8±2.4; p&lt;0.001); morning stiffness (5.8±2.4 vs. 4.8±2.4; p&lt;0.001), work impact (56.5% vs. 38.2%; p&lt; 0.001); anxiety (56.8% vs. 12.5%; p&lt;0.001); depression (51.8% vs. 10.1%; p&lt;0.001) and higher GHQ-12 scores (6.4±4.0 vs. 3.9±3.9; p&lt;0.001). However, factors that remained independently associated with sleep disorders in the multivariable analysis were anxiety (OR=3.8 p&lt;0.001) and depression (OR=3.1 p&lt;0.001) and female gender (OR=1.4; p=0.002) [Table 1]. Table 1. Regression analysis to predict presence of sleep disorders (N=2191) Simple logistic regression Multivariable logistic regression OR 95% CI p-value OR 95% CI p-value Gender (female) 1.59 1.36-1.87 &lt;0.001 1.40 1.13-1.73 0.002 Marital status (married) 1.13 0.99-1.28 0.074 NA NA NA Overweight/Obesity 1.31 1.12-1.53 0.001 1.39 1.14-1.71 0.001 BASDAI (0-10) 1.33 1.27-1.39 &lt;0.001 1.07 0.95-1.21 0.246 Fatigue/Tiredness (0-10)* 1.28 1.23-1.33 &lt;0.001 1.04 0.97-1.12 0.271 Morning Stiffness intensity (0-10)* 1.19 1.15-1.23 &lt;0.001 1.05 0.98-1.13 0.188 Reported Work impact (yes) 2.10 1.78-2.48 &lt;0.001 1.29 1.05-1.58 0.015 Anxiety (yes) 9.18 7.58-11.11 &lt;0.001 3.84 2.99-4.94 &lt;0.001 Depression (yes) 9.53 7.78-11.66 &lt;0.001 3.09 2.37-4.02 &lt;0.001 GHQ-12 (0-12)** 1.16 1.14-1.19 &lt;0.001 1.03 1.00-1.06 0.029 *As measured by the respective item of the BASDAI scale. **12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental health. Conclusion: Sleep disorders were highly prevalent among axSpA European patients and strongly associated with female gender and reporting worse mental health, and spinal stiffness. Patients on permanent and temporary sick leave were more likely to report sleep disorders. The strong association between sleep disorders with both anxiety and depression should encourage rheumatologists to screen their patients with sleep disturbance in case they require additional specialist support. Acknowledgements: This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the 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., Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.