PURPOSE: Tumor necrosis factor (TNF) has been identified as a potential central mediator of sleep. We evaluated and compared polysomnographic (PSG) characteristics pre and post-inititation of anti-TNF therapy in rheumatoid arthritis (RA) patients.
METHODS: Consecutive RA patients about to initiate anti-TNF therapy were recruited to participate in an assessment of sleep health. Prior to initiation of therapy, patients underwent an overnight PSG and completed a self-administered questionnaire. The questionnaire included the Pittsburgh Sleep Quality Index (PSQI) and Epworth sleepiness score (ESS). The PSG study and questionnaire assessments were repeated after ongoing anti-TNF therapy had been established.
RESULTS: Ten RA patients consented to participate in this study. Seven were women. The mean age was 57.75 years (range 45-85). Mean body mass index was 31.04 kg/m2, (SD 5.92, range: 25.6-42.5). Mean PSG characteristics in the baseline study included: Apnea-hypopnea index (AHI) 13.02 (SD 13.59), respiratory disturbance index (RDI) 16.4 (SD 17.74), periodic limb movements (PLMs) 18.34 (SD 24.78), arousing PLMs 4.43 (SD 9.51), sleep efficiency 73.86% (SD 13.53), total arousals 132.2 (SD 103.83), arousal index 26.18 (SD 24.34), sleep latency 34.55 (SD 44.19), total number of sleep stage transitions/hour 26.51 (SD 11.64), wake after sleep onset (WASO) 84.1 minutes (SD 43.24), % stage 1 sleep 21.22 (14.08), % stage 2 sleep 47.17 (SD 7.61), % slow wave sleep 18.03 (SD 11.10), and %REM sleep13.57 (SD 8.37). The post-treatment initiation PSG parameters were compared to the pre-treatment values. Improvement was seen in sleep efficiency to 85.4% (SD 9.62, p=0.031) and in WASO measurement which dropped to 50.69 (SD 36.48, p=0.048). No significant differences were observed in the other PSG measurements. No differences in ESS or PSQI scores by questionnaire were observed between the two time points.
CONCLUSION: Improvements in sleep efficiency and WASO measurements were observed following initiation of anti-TNF therapy in this RA patient study population.
CLINICAL IMPLICATIONS: There is some evidence that sleep is improved in RA patients receiving anti-TNF therapy.
DISCLOSURE: John Gjevre, No Financial Disclosure Information; No Product/Research Disclosure Information