AB0885-HPR SLEEP IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: C. Andersen, K. M. Latocha, B. A. Esbensen
Journal: Annals of the Rheumatic Diseases (2021)

Background: Many patients with rheumatoid arthritis (RA) live with the consequences of arthritis in everyday life. Sleep disturbances, including insomnia, are highly prevalent and a complex issue that increases existing RA-related symptoms, such as pain, fatigue, and depressed mood. To our knowledge, only two studies have qualitatively investigated the patient perspective and experiences of sleep in people with RA (1-2). Objectives: To investigate how people with RA and concomitant sleep disturbances describe their sleep and experience everyday life with poor sleep. Methods: This study is a qualitative phenomenological study. In total, 14 people with RA and sleep disturbance were recruited from an RCT study (3) from the Center for Rheumatology and Spine Diseases at Rigshospitalet in 2012. Semi-structured interviews were performed after the last follow-up in the RCT. The analysis was based on Giorgis’ descriptive phenomenological psychological analysis. Results: For the characteristics of participants, see Table 1. We identified six essences; 1) “ When sleep is put into words ” covered that the participants described their poor sleep experiences simultaneously to their wishes for good sleep still existed. 2) “ The struggle to sleep ” included participants’ descriptions of difficulties sleeping and how thoughts and worries could interfere with sleep at night. 3) “ Pain is a companion day and night ” included how pain affected sleep and how participants had problems with pain management. 4) “ To take sleep in their own hands ” described how the participants tried to create their framework for sleeping and how they also strove to reach out for help from, e.g. of professionals. 5) “ Everyday life in the shadow of sleep ” included the overwhelming fatigue, a need to rest during the day, and how social relationships were affected negatively. 6) “ Adapt to the circumstances ,” which meant that the participants tried to seek shelter behind a facade, and at the same time tried to learn to live with the consequences of poor sleep in everyday life. People with RA and sleep disturbances describe several challenges that affect their sleep, e.g., pain, thoughts at night, and many reasons for awakenings. Participants in this qualitative study were not aware of the difference between fatigue and poor sleep, both regarding reasons for occurring and management of the two highly prevalent consequences of RA. At the same time, they believed that health professionals lacked knowledge on sleep disturbances and management hereof in people with RA. Conclusion: When people with RA and concomitant sleep disturbance describe their sleep, a struggle to sleep was most often described, characterized by pain, thoughts, difficulty falling asleep, and many and early awakenings. Everyday life experience with sleep disturbances was marked by fatigue and sleep deprivation, negative impact on social skills and relationships, and failure when they reached out for help. Table 1. Characteristics of participants (N=8 ) Age, median (range) 50 (44-60) Sex, Women, n % 7 (77,8%) RA-related Duration of RA, median (range) 14,75 (6-32) DAS28-CRP, median (range) 1 1,9 (1,62-3,03) Physical function, HAQ, median (range) 1 0,5 (0,000 – 2,13) Sleep PSQI, median (range) 2 9,5 (6-15) Fatigue VAS fatigue, median (range) 33,4 (2-65) BRAF-MDQ, median (range) 3 25,5 (4-36) Pain VAS pain, median (range) 25 (0-60) Quality of Life VAS global, median (range) 45,6 (8-40) 1 Disease activity score-28 C-reactive protein 2 Health Assessment Questionnaire, score 0-3 (Higher score indicates worse physical functioning. 2 Pittsburgh Sleep Quality Index, score 0-21 (score of 5 or more indicates sleep disturbances) 3 Visual Analog scale, score 0-100 (higher score is worse) 4 Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire score 0-70(higher score indicates more fatigue) References: [1]Short V et al; Annals of the Rheumatic Diseases. 2017;76(Suppl 2):519. [2]McKenna S, et al; EULAR. 2020; OP0267-HPR (2020). [3]Løppenthin et al; BMC Musculoskeletal Disorders 2014, 15:49. Disclosure of Interests: Camilla Andersen: None declared, Kristine Marie Latocha: None declared, Bente Appel Esbensen Speakers bureau: Bente Appel Esbensen has received speaking fees from Pfizer and Eli Lilly.