LAUSR

Background Sleep problems and fatigue are very common in rheumatic diseases and painful conditions. There is mounting evidence that sleep problems and fatigue have reciprocal influences on musculoskeletal pain, mood, and overall well-being of patients with rheumatic disorders. In addition, sleeping problems are a risk factor for developing chronic widespread pain. Objectives To assess and compare sleep problems and fatigue in a cohort of patients with AS, RA and FM. Methods We conducted an online survey with patients regularly attending the Gastein Healing Galleries in Bad Gastein, Austria. In this health facility appr. 12,000 patients with a variety of disease are being treated annually. Of those, 6,465 patients were invited by email to fill out the survey anonymously. Sociodemographics and disease related variables (e.g. pain, depression) were assessed, including current health status, three items concerning sleep quality, duration of sleep problems, and the number of nights affected by sleep problems, and four items from the Multidimensional Fatigue Inventory (general fatigue subscale) concerning feeling fit, tired, rested, and tiring easily. Results In total 2,017 patients responded (=31%) of which a subset of 784 respondents indicated a diagnosis of AS (43%), RA (40%), or FM (17%). Their mean age (SD) was 58 years (11) and 53% were male. Level of education was: Elementary School 30%, Junior High School 22%, High School 20%, College 13%, and University 15%. Only 17% of AS, 20% of RA and 12% of FM patients indicated that their sleep quality is not affected. In 51.6% of AS, 47.2% of RA and 64% of FM patients the duration of the sleeping problem persists more than one year. Examining levels of sleep problems and fatigue across these three groups revealed significant variation (p<.001). Regarding sleep problems, FM patients showed significantly higher levels of problems than AS (p<.001) and RA patients (p<.001), and the latter two groups do not significantly differ. FM patients reported significantly higher levels of fatigue than AS (p<.001) and RA patients (p<.001), and AS patients had significantly higher levels of fatigue than RA patients (p<.001). Fatigue and sleep problems were correlated in expected directions with depression, pain, and health. However, while there was little variability in the magnitude of the associations between fatigue and sleep problems with depression and pain, there was considerable variation in the association of fatigue and sleep problems with health. AS patients showed a small and non-significant association, whereas, RA patients showed a larger association (r≈.20) and FM patients showed the largest association (r≈.5). Conclusion We found sleep problems and fatigue to be common, chronic and elevated in AS, RA and FM, but not equally so across diagnostic categories. FM patients showed the greatest problems with sleep and fatigue. Furthermore, it appears that fatigue and sleep problems may have the most important connection to health for FM patients. To conclude, it is important to address sleep problems and fatigue in routine clinical assessment and management of patients with AS, RA and FM. Disclosure of Interests None declared