AB1104 THE RELATIONSHIP BETWEEN QUALITY OF SLEEP AND CYTOKINES IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: P. Richter, M. A. Burlui, C. A. Adam, D. Popescu, E. Rezus
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Sleep disturbances are frequently observed in patients with autoimmune diseases, potentially leading to a negative impact on overall quality of life. Sleep disorders can elevate proinflammatory cytokines, although literature data shows that the connection between sleep and inflammation is bidirectional. <h3>Objectives:</h3> We examined the sleep quality in SLE patients, investigating the association between sleep disorders and disease parameters, including interleukins (IL-6, IL-17A, IL-10), tumor necrosis factor (TNF)-α, and inflammatory markers. <h3>Methods:</h3> We conducted a prospective cohort study of SLE adult patients admitted at the Reumatology Departament of the Clinical Rehabilitation Hospital Iasi. Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires were used to assess the daytime sleepiness and sleep quality. Serum concentrations of IL-17A, IL-10, IL-6, and TNF-α were determined with enzyme-linked immunosorbent assay (ELISA) method. Disease activity was assessed using SLE disease activity index (SLEDAI). <h3>Results:</h3> We included in our study 53 SLE patients, mostly female (47 cases, 88,7%) with a mean age of 50,15 ± 16,30 years-old and mean disease duration of 11,49 ± 9,57 years. As for comorbidities, 9.43% of our group had anxious-depressive syndrome (5/53). Analysis of the overall group identified mean serum values of 6.32 ± 2.20 pg/ml for IL-17A and 8.10 ± 7.66 pg/ml for IL-6, 19.10 ± 34.20 pg/ml for IL-10, and 18.74 ± 8.17 pg/ml for TNF-α. The mean value for PSQI score was 6,70 ± 3,41 and for ESS 6,09 ± 4,06. PSQI classified patients into good sleepers (PSQI ≤ 5) and sleep disorder group (PSQI &gt; 5). The poor sleep was noted in 52,83% (28/53) of SLE patients. Furthermore, only one patient had ESS greater than 16, indicating excessive daytime sleepiness. Although the most frequent reported symptom at admission was joint pain (77,36%), it was not associated with sleep quality in our study group. The mean value of SLEDAI was 3,94 ± 3,16. Using a SLEDAI cutoff score≥6, SLE patients were divided as either having active (30,19%) or inactive disease (69,81%). Poor sleep was noted in 43,75% (7/16) of patients with clinically active and in 56,76% (21/37) of patients with inactive disease. Particularly in patients with inactive disease, high levels of IL-17A correlated with elevated levels of ESS (p=0.031), but not in active disease. In good sleepers patients with inactive disease, elevated levels of IL-10 (p=0.025) and inflammatory markers such as erythrocyte sedimentation rate (p=0.003) and C-reactive protein (p=0.029) showed a positive correlation with total PSQI score. We found increased levels of ESS that were directly associated to a medical history of anxiety and depressive disorders (p=0.042) in patients with active disease; further, we wanted to evaluate the potential link between these comorbidities and cytokines. IL-17A concentration correlated with these psychiatric diseases (p=0.043). In both patients with active and inactive disease, the correlation maintained statistically significant (p=0.038 and p=0.027). Moreover, positive correlation between CRP and depression-anxiety conditions was seen in active disease (p=0.002). Also in active disease, TNF-α appeared to be positively associated with the comorbid depression in patients with sleep disorders (p=0.021). Interestingly, the increase in PSQI score is directly associated (p=0.020) with older age of patients (Figure 1). <h3>Conclusion:</h3> High levels of IL-17A correlated with high levels of daily sleepiness according to ESS scale, in patients with inactive disease. Improving circadian rhythm abnormalities should become a promising focus in SLE patients. In addition to treat sleep disorders, it may also be beneficial to control mental disorders in order to optimize their quality of life. Among all the studied cytokines, it appears that serum IL-17A is a good indicator of depression and anxiety in SLE patients. This association remains to be confirmed in larger cohorts. <h3>REFERENCES:</h3> [1] Ditmer M, Gabryelska A, Turkiewicz S et al. Problems in Chronic Inflammatory Diseases: Prevalence, Treatment, and New Perspectives: A Narrative Review. J Clin Med. 2021 Dec 23;11:67 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>