Assessing Sleep in Patients with Rheumatoid Arthritis Using Actigraphy

Shelby Rader

It’s common for patients with rheumatoid arthritis (RA) to experience poor sleep, however, not many of them recognize the issue or address it with their rheumatologist during their clinical visits, according to new research presented at the Associated Professional Sleep Societies (SLEEP) 2022 Annual Meeting.

A team of investigators including Shelby Rader, University of South Carolina School of Medicine Greenville, performed a study to determine if actigraphy could serve as a complementary clinical tool for sleep evaluation in patients with rheumatoid arthritis. Findings suggested there’s potential that actigraphy may provide additional information to self-reported sleep measures.

“The objective of this study was to identify correlations between sleep measures assessed through self-report and actigraphy with disease activity for patients with RA,” investigators wrote.

The Struggle of Sleep Assessment

There’s no accountable standard method of sleep measurement used within clinical care. Investigators noted this, along with an overall lack of patient confidence in their ability to communicate how rheumatoid arthritis impacts sleep, as the primary inhibitors to identifying sleep issues.

Beyond identification challenges, insufficient evidence surrounding the relationship between sleep quality and disease symptomology complicates clinical management when patients experience poor sleep.

Investigators aimed to establish if including another clinical tool—actigraphy, in this study—could offer additional insight to the correlations between sleep and disease activity in these patients, as opposed to relying primarily on self-reported sleep measures.

The Measurement Methods

The study population was generally reflective of the population with rheumatoid arthritis—mostly Caucasian women with an average age of 55 years. A total of 15 patients diagnosed with rheumatoid arthritis were recruited for the prospective, cross-sectional study through convenience sampling.

The patients used the Pittsburgh Sleep Quality Index (PSQI) and Routine Assessment of Patient Index Data 3 (RAPID-3) to self-report sleep quality and disease activity. Alongside self-reported measures, actigraphy was utilized to collect sleep quality information. For actigraphy to work, patients wore a watch that monitored their wrist movement for 6 nights.

Sleep efficiency, latency, and fragmentation were measured by daily actigraphy, and information collected throughout the 6-night time period was averaged. Then these measures were correlated to the PSQI and RAPID-3 measures through Spearman correlations.

Correlations and Results

Investigators found that the demonstrated correlations were weak and nonsignificant between self-reported measures of sleep and average sleep efficiency (0.12, p=0.66), latency (0.10, p=0.72), and fragmentation (-0.13, p=10).

The correlations identified between disease activity and average sleep efficiency (0.09, p=0.75), latency (0.35, p=0.19), and fragmentation (-0.12, p=65) were also weak and nonsignificant.

The implications, as stated by the investigators, suggested that actigraphy may provide complementary information to self-reported sleep measures and such information could potentially support patients’ ability to articulate issues associated with sleep to a rheumatologist.

“Further research is necessary to understand how actigraphy measures can be effectively summarized for use by the patient and rheumatologist to discuss sleep issues during the clinical encounter as well as their ability to support clinical diagnosis of sleep disorders,” they concluded.