Low Wellness/Health Score Associated With Poor Sleep Quality

A low patient-reported wellness/health score for patients with rheumatoid arthritis (RA) was linked to poor sleep quality, longer sleep duration on weekends, longer nap duration on weekdays, and decreased mood, according to a study published in BMC Rheumatology.¹

“Self-rated wellness/health has been shown to provide a reliable subjective picture of well-being and health status,” investigators stated. “It seems there are bidirectional relationships among the three sides of triangle: chronic disease manifestations, lifestyle factors and self-rated wellness/health. Then, understanding the complex inter-relationships in this triangle in RA might be an important aspect for any patient-centered clinical practice and management plan.”

In this cross-sectional study, investigators evaluated patients with RA based on patient-reported wellness and health, mood, sleep, diet, smoking history, disease activity, demographics, body mass index (BMI), and laboratory records. Sleep quality was analyzed by Mini-Sleep Questionnaire, with a higher score indicating worse sleep quality. Mood was measured using the Gallup Wellbeing Index, in which a higher score implied worse mood status. A multivariable generalized additive model (GAM) was performed to examine any connection between the data.

A total of 142 patients were identified. The mean age was 52 years, 116 patients were female, and BMI was generally classified as overweight. The wellness/health score averaged 7.2/10, with 10 being the healthiest, the mean number of tender joints was 4.42, and the average number of swollen joints was 4.00. Common comorbidities included hypothyroidism (14.1%), diabetes mellitus (2.8%), and cardiovascular disease (2.8%). Nearly all (96%) of patients were being treated with corticosteroids. Mean sleep score was 29.5 out of 70. Mood and diet scores averaged 18.5/35 and 22.5/42, respectively.

Mood status and time to fall asleep were the 2 most significant variables were linearly associated with the wellness/health score. In the multivariable GAM regression, mood status, sleep quality, sleep duration, and nap duration during weekends were the most significant variables.

When compared with patients who reported the best sleep, a 20% drop in self-reported wellness/health score was observed for those who had the worst sleep quality. Six out of 10 sleep quality assessments were more common in patients with RA. A total of 76% reported sleep fragmentation and 86% stated they woke up too early more than 3 nights per week. Additional factors associated with poor sleep quality were difficulty falling asleep (45%), falling asleep during the day (45%), feeling tired upon waking (49%), and snoring (35%).

Patients went to bed earlier and woke earlier during the weekdays when compared with the weekends (22:45 vs 23:52 PM; 6:08 vs 7:20 AM, respectively). Those who woke up at 7 AM or earlier tended to have a higher self-rated wellness/health score when compared with those who woke up later (7.23 vs 7.14, respectively). Patients who went to bed between 11:00 PM and midnight had the highest scores (7.59) when compared with those who went to bed before 11:00 PM (6.96) or after midnight (6.11).

Naps averaged approximately 30 minutes longer on the weekends when compared with weekdays (48.02 vs 19.75 minutes, respectively). Any nap longer than 30 minutes was linked to a lower wellness/health score. The mean score for patients who took 5- to 30-minute naps was 7.39, compared with a score of 6.33 for those who took longer naps.

The highest scores were seen in 55 individuals who went to bed between 11:00 PM and midnight, woke up at 7 AM or earlier, and napped between 0 to 30 minutes when compared with the rest of the group (7.66 vs 6.94, respectively).

Strengths of the study included using patient-reported outcomes as the primary endpoint, with a focus on sleep quality and quantity during both the weekday and weekend. Analyzing lifestyle factors, clinical findings, and disease activity helped to design the multivariable GAM. However, the cross-sectional nature did not allow for cause-and-effect examination between wellness/health score and sleep quality. Further, unless witnessed by a third party, self-reported snoring statistics may be inaccurate.

“Mood and sleep emerged as the most important factors in the final GAM regression model associated significantly with self-rated wellness/health score in patients with rheumatoid arthritis,” investigators concluded. “The model showed that too much sleep duration on weekend, more than 30-minute naps on weekdays, and lower sleep quality were the main sleep indices associated with lower self-rated wellness/health score.”

Reference:

Tabaraii R, Masoumi M, Bagherzadeh-Fard M, Yazdanifar MA, Balasi J, Smiley A. Association of lifestyle and disease characteristics with self-rated wellness/health score in patients with rheumatoid arthritis. BMC Rheumatol. 2021;5(1):55. Published 2021 Dec 22. doi:10.1186/s41927-021-00227-x