Actigraphic and self-reported characterization of sleep in systemic lupus erythematosus patients

Rheumatology (Oxford). 2023 Jul 11;kead344. doi: 10.1093/rheumatology/kead344. Online ahead of print.


Objective: In a cross-sectional study, we explored possible differences in sleep parameters between Systemic Lupus Erythematosus (SLE) patients and age- and gender-matched healthy controls through actigraphic and self-reported measures. Furthermore, we aimed at identifying possible predictors of such disturbances in the patients' cohort.

Methods: Participants' sociodemographic data and sleep parameters were collected. Sleep parameters were evaluated through the Pittsburgh Sleep Quality Index, the Insomnia Severity Index (ISI) and a 7-day actigraphic monitoring. The Perceived Stress Scale-10 was used to investigate stress. Disease activity and daily glucocorticoid dose were assessed in SLE patients. Possible predictors of the SLE group were explored through two binomial logistic models. Within the SLE group, possible predictors of sleep parameters were tested estimating multiple linear regression models.

Results: 40 SLE patients and 33 controls were included in the study. SLE group showed worse sleep maintenance actigraphic parameters (i.e., sleep efficiency and wake after sleep onset), higher total sleep time and higher perceived stress. Within the SLE cohort, daily glucocorticoids dose was associated with an impairment in sleep maintenance despite no reduction in sleep duration, typical of normal sleep duration insomnia, whereas perceived stress was associated with short sleep duration insomnia.

Conclusion: Compared to healthy controls, SLE patients showed worse sleep quality and greater perceived stress severity. As glucocorticoids and perceived stress promote different types of insomnia in these patients, a multidimensional approach to both sleep characterization and therapy might hence be preferred.

Keywords: coping factors; immunosuppressants; nervous; quality of life; systemic lupus erythematosus.