Positive Personality Traits May Impact Sleep Issues in Patients with RA

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A study shows positive personality traits and perceived disease impact might play a major role in explaining sleep disturbances in patients with rheumatoid arthritis (RA). The data was presented in an abstract at the 2024 European Alliance of Association for Rheumatology (EULAR) from June 12 – June 15, 2024, in Vienna, Austria.¹

Experiencing chronic pain, such as with RA, may make it difficult to get a good night’s sleep. Approximately 38% of patients with RA have sleep disturbances, and according to the Arthritis Foundation, 80% of people with RA report symptoms of fatigue.² Studies have shown patients have high pain levels at night—1 study found among the 28% of participants who recorded night pain, their nocturnal pain had significantly more joint tenderness (P < .0001) swollen joints (P < .0001), greater erythrocyte sedimentation rate, and C-reactive protein.³

However, new research shows disease activity itself plays a secondary role in explaining sleep disturbances in RA—with personality traits and perceived disease impact having greater influence.¹

Investigators, led by M.J. Cadório, from Coimbra Hospital in Portugal, aimed to better understand sleep disturbances in patients with RA through a multifactorial explanatory model, examining the influence of disease activity, perceived disease impact, personality traits, and the comorbidities of depression and anxiety on sleep. They conducted a cross-sectional analysis of 302 participants with RA from an outpatient clinic in a tertiary Portuguese hospital.

The team assessed sleep disturbance with the Sleep Disturbance item (0 – 10) from the Rheumatoid Arthritis Impact of Disease questionnaire, disease impact with the individual domains also on the Rheumatoid Arthritis Impact of Disease questionnaire, and disease activity with the Disease Activity Score 28 joints in 3 variables and C-reactive protein variant. Additionally, depressive and anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale.

Lastly, personality was evaluated with the Ten Item Personality Inventory. Investigators categorized the latent factor of the inventory as the “positive” personality, which included traits of extraversion, agreeableness, consciousness, emotional stability, and openness to experiences. The disease impact was measured by pain, functional disability, physical well-being, emotional well-being, and fatigue.

The multifactorial model explained 57% of the variance of sleep disturbances. “Positive” personality and disease activity explained 46% of the variance of the perceived impact of the disease. The model showed a direct association between disease activity and disease impact (P < .001), both of which significantly impact sleep disturbance (P < .001).

“Positive” personality traits provided a total protective effect on sleep disturbance, both direct (P = .006) and indirect (P = .001). The perceived impact of disease mediated the relationship between positive personality traits and sleep disturbances. The model demonstrated a direct negative relationship between positive traits and the perceived impact of disease (P < .001).

Furthermore, depression displayed a significant positive direct relationship with disease impact (P = .005) and a significant negative direct relationship with positive traits (P < .001). Anxiety also demonstrated a significant negative direct relationship with positive traits (P < .001).

“Positive personality traits and perceived impact of disease seem to have a major role in explaining sleep disturbances in patients with RA,” investigators concluded. “In contrast, disease activity and comorbidities such as depression and anxiety play a secondary role. This evidence reinforces the need to consider a multidisciplinary approach to people living with RA, that goes beyond a treat-to-target strategy focused solely on disease activity.”

References

1. ^{Cadório, M, Santos, E, Oliveira, J. Ab0544 Multifactorial Explanatory Model of Sleep Disturbance in Patients with Rheumatoid Arthritis: A Structural Equation Approach. Abstract presented at European Alliance of Association for Rheumatology from June 12 – June 15, 2024, in Vienna, Austria.}
2. ^{Rheumatoid Arthritis and Sleep. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/fatigue-sleep/rheumatoid-arthritis-and-sleep. Accessed June 25, 2024.}
3. ^{Rojkovich, B and Gibson, T. Day and Night Pain Measurement in Rheumatoid Arthritis. BMJ Journals, Annuals of the Rheumatic Diseases. https://ard.bmj.com/content/57/7/434. Accessed June 25, 2024.}