Associated factors and psychotherapy on sleep disturbances in systemic lupus erythematosus

Sleep disturbance is a common problem in systemic lupus erythematosus (SLE) patients. This study was performed to determine the prevalence of sleep disturbance in SLE, the factors that might be associated with sleep disturbance, and the correlation between changes in clinical parameters and sleep quality over time. Fifty-six female SLE patients from a total of 497 SLE patients (11.3%) agreed to join the study. The demographic data were recorded at baseline and the clinical data, the Pittsburgh Sleep Quality Index (PSQI) and other standardized assessment tools, disease activity index, quality of life (QoL), damage index, depression, anxiety and fatigue score, were assessed three times: the first visit was at baseline, the second time was one month later, and the third time was three months after the baseline. Thirty-one of these 56 patients (55.36%) were found to have sleep disturbances. All were females with their mean +/- SD age of 37.5 +/- 12.3 years, and disease duration at study entry of 8.6 +/- 7.3 years. There was no association between sleep disturbances and demographic data, disease activity, clinical symptoms, the presence of autoantibodies and current steroid use. In multiple logistic regression analyses, only moderate to severe depression was the independent determinant of sleep disturbances, p=0.036. During the three-month observation, with the treatment, the changing of total PSQI score showed a significantly positive correlation with depression, anxiety, pain and QoL. Sleep disturbances in Thai SLE patients were not uncommon but a correctable condition. Depression was strongly associated with sleep disturbances. Awareness of underlying depression as well as sleep disturbances in SLE patients and treating them properly improve QoL in SLE.