The British Journal of Rheumatology, Vol 37, 71-81, Copyright © 1998 by British Society for Rheumatology
AM Drewes, L Svendsen, SJ Taagholt, K Bjerregard, KD Nielsen and B Hansen
Sleep complaints are frequent in patients with rheumatoid arthritis (RA)
and sleep disturbances may contribute to pain and other daytime complaints.
The aims of the current study were to compare ambulatory sleep recordings
from consecutively selected patients with RA to those obtained in healthy
controls, and to study the relationships between sleep structure and
clinical symptoms. Sleep recordings were obtained from 41 out-patients with
RA and 19 matched controls. All had clinical examinations and completed
different questionnaires. Recordings were scored traditionally and,
moreover, the electroencephalography (EEG) was subjected to frequency
analysis. For the study of sleep-wake interactions in the patients, a
graphical chain model was used. The patients had many sleep-related
complaints. An increase in the number of periodic movements of the legs
(PML) during sleep was seen in comparison with controls, but otherwise only
minor differences were observed in classical sleep stages. Data from
frequency analysis showed an increase in alpha (8-12 Hz)-EEG activity in
sleep stages non-rapid eye movement (NREM) 2-4 in most sleep cycles. The
statistical model demonstrated a complex but independent correlation
between morning stiffness, pain and joint tenderness on the one hand, and
awakenings, stage NREM2, slow-wave sleep and stage REM on the other,
probably reflecting a relationship between sleep patterns and pain in RA.
In conclusion, only the increase in PML and alpha-EEG activity
distinguished the sleep in RA patients from that of healthy controls.
However, the demonstrated interaction between daytime complaints and sleep
patterns may increase the understanding and treatment of the disease. In
future research, graphical chain models may improve our understanding of
complex relationships between multiple variables.
ORIGINAL PAPERS
Sleep in rheumatoid arthritis: a comparison with healthy subjects and studies of sleep/wake interactions
Department of Internal Medicine M, Aalborg Hospital, Denmark.
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