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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (6): 1063-1068. doi: 10.19723/j.issn.1671-167X.2020.06.012

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Investigation of sleep disturbance and related factors in patients with primary Sjögren’s syndrome

Yi-fan WANG1,Zhen FAN2,Yao-bin CHENG1,Yue-bo JIN1,Yang HUO3,Jing HE1,△()   

  1. 1. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Rheumatology and Immunology, Jinmen NO.1 People’s Hospital, Jingmen 448000, Hubei, China
    3. Department of Neurology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2020-07-13 Online:2020-12-18 Published:2020-12-13
  • Contact: Jing HE E-mail:hejing1105@126.com
  • Supported by:
    National Natural Science Foundation of China(31870879);National Natural Science Foundation of China(81701607)

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Abstract:

Objective: To investigate the prevalence of sleep disorders and the relevant determinants in a cohort of primary Sj?gren’s syndrome (pSS) patients. Methods: One hundred and eighty-six pSS patients were included in the study, who were admitted to Peking University People’s Hospital and met the criteria of inclusion and exclusion. Sleep quality was assessed using the Pittsburgh sleep quality index(PSQI).Depression, anxiety were evaluated by patient health questionnaire (PHQ)-9,generalized anxiety disorder(GAD)-7, respectively. The demographic and clinical data were also recorded.Disease activity and damage were evaluated with the European League Against Rheumatism Sj?gren’s syndrome disease activity index (ESSDAI). According to the PSQI score>7, the pSS patients were divided into 152 cases of sleep disorder group and 34 cases of normal sleep group. Mann-Whitney U test, Chi-square test or Fisher’s exact test, independent samples t test, Spearman correlation analysis and Logistic regression were used for statistical analysis. Results: The prevalence of sleep disturbance (PSQI>7) was 81.7% (152 / 186) in the pSS patients, and 52.7% (98/186) had moderate or severe sleep disorders (PSQI≥11). The mean PSQI score of sleep disordered group was (12.29±3.30), while the normal sleep group PSQI score was (5.50±1.20). The PSQI score, PHQ-9 score and GAD-7 score in the sleep-disordered group were significantly higher than those in the normal sleep group (P=0.000, 0.035, 0.031). The PSQI score in the sleep disordered group were significantly higher than those in the normal sleep group in seven aspects: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disorders, hypnotic drug use and daytime dysfunction. All of them had statistical significance. According to the results of Spearman correlation analysis, PSQI had significantly positive correlation with course of disease, anxiety, depression score (r=0.151, 0.240, 0.421, P<0.05), but negatively correlated with C3,C4 (r=-0.021, -0.235, P<0.05). Logistic analysis identified the course of disease(OR=2.809, 95%CI: 1.21-6.52)and PHQ-9 score(OR=1.422, 95%CI: 1.04-1.94)as predictors of sleep disorders. Conclusion: The incidence of sleep disorder in the pSS patients was higher, which was closely related to the course of disease, anxiety, depression and other factors. It is critical to assess and manage comprehensively the disease.

Key words: Sj?gren's syndrome, Sleep disorders, Anxiety, Depression, Risk factors

CLC Number: 

  • R783.2

Table 1

Comparison of general data between the two groups of pSS patients"

Items Sleep-disordered group Normal sleep group P value
Total cases, n 152 34
Female/% 96.1 100 0.538
Age/years, M (P25, P75) 59.5 (54.25,65) 64.0 (54.5,67) 0.456
Disease duration/ years, M (P25, P75) 7.5 (3,7.5) 3 (3,7.5) 0.024*
BMI/(kg/m2), M (P25, P75) 21.8 (20.1,23) 23.4 (22,25.3) 0.061

Table 2

Comparison of laboratory features between the two groups of pSS patients"

Items Sleep-disordered group Normal sleep group P value
WBC/(×109/L), M (P25, P75) 5.0 (4.6,5.4) 4.9 (4.5,5.4) 0.351
HGB/(g/L), x-±s 127±19.9 130±11.8 0.366
PLT/(×1012/L), M (P25, P75) 194 (180,208) 196 (168,227) 0.846
ESR/(mm/h), M (P25, P75) 21.2 (17.0,25.4) 21.7 (12.5,30.8) 0.727
CRP/(mg/L), M (P25, P75) 5.0 (0.9,9.0) 1.6 (0.3,3.5) 0.016*
α-fodrin/(RU/mL), M (P25, P75) 18.1 (13.3,23.1) 15.7 (5.9,25.5) 0.082
RF /(IU/mL), M (P25, P75) 171 (13.8,329) 101 (19.0,184) 0.144
IgA/(g/L), x-±s 3.8±4.1 2.9±1.7 0.213
IgG/(g/L), M (P25, P75) 14.6 (13.1,16.1) 16.6 (14.1,19.2) 0.211
IgM/(g/L), M (P25, P75) 1.3 (1.1,1.5) 1.2 (0.9,1.6) 0.714
C3/(g/L), x-±s 0.9±0.2 0.9±0.1 0.925
C4/(g/L), x-±s 0.2±0.1 0.3±0.3 0.171
γ globulin/%, M (P25, P75) 20.6 (19.1,22.1) 21.7 (19.1,24.3) 0.103
RBP/(mg/L), x-±s 1.12±3.1 0.3±0.1 0.085
β2-MG/(μg/L), M (P25, P75) 695 (63.0,1327) 262 (87.8,437) 0.781
NAG(U/L), M (P25, P75) 10.2 (8.7,11.7) 14.8 (9.0,20.5) 0.989

Table 3

The PSQI score of pSS patients of sleep-disordered group and normal sleep group"

Items Sleep-disordered group Normal sleep group P value
Total cases, n 152 34
Subjective sleep quality, M (P25, P75) 1 (1,2) 1 (0,1) <0.001*
Sleep latency, M (P25, P75) 2 (2,3) 1 (1,1) <0.001*
Sleep duration, M (P25, P75) 1.5 (1,2) 1 (0,1) 0.004*
Sleep efficiency, M (P25, P75) 3 (2,3) 1 (0,1) <0.001*
Sleep disturbance, M (P25, P75) 1 (1,1) 1 (1,1) 0.027*
Hypnotic drug use, M (P25, P75) 1 (1,2) 1 (0,1) <0.001*
Daytime dysfunction, M (P25, P75) 2 (2,3) 1 (1,2) 0.001*
PSQI global, x-±s 12.29±3.30 5.50±1.20 <0.001*

Table 4

The PHQ-9 score and GAD-7 score of pSS patients of two groups"

Items Sleep-disordered group Normal sleep group P value
Total cases, n 152 34
PHQ-9, M (P25, P75) 6 (4,8) 4 (2,5) 0.035*
GAD-7, M (P25, P75) 3.5 (2,6) 2 (1,4) 0.031*
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