J Rheum Dis.  2021 Jul;28(3):143-149. 10.4078/jrd.2021.28.3.143.

Bath Ankylosing Spondylitis Disease Activity Index is Associated With the Quality of Sleep in Ankylosing Spondylitis Patients

• Song BW
• Jeong HJ
• Kim BY
• Cho YW
• Son CN
• Kim SS
• Kim SH

• KMID: 2516950
• DOI: http://doi.org/10.4078/jrd.2021.28.3.143

Abstract

Objective
High disease activity of ankylosing spondylitis (AS) is associated with poor sleep quality. The purpose of this study was to identify which of the representative tools for evaluating the disease activity of AS best reflect the quality of sleep.
Methods
A total of 107 AS patients were enrolled in the study and the sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Age, sex, concomitant medication, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) level, Beck Depression Inventory second edition (BDI-II), Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAS)-ESR, ASDAS-CRP, pain visual analog scale, Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS) were analyzed as covariates.
Results
Overall, 65% (70/107) of subjects reported poor sleep quality (PSQI＞5). There was a positive correlation between the sleep quality and disease activity as measured by the BASDAI, ASDAS-ESR, and ASDAS-CRP. In addition, the BASDAI demonstrated good correlations with ISI, ESS, and BDI-II, respectively. However, only BASDAI showed reliable correlation with PSQI among the disease activity parameters of AS (adjusted odd ratio 5.36, p=0.023).
Conclusion
BASDAI is the most reliable parameter of disease activity associated with the sleep quality in patients with AS.

Keyword

Ankylosing spondylitis; Bath ankylosing spondylitis disease activity index; Sleep quality

Reference

1. Sieper J, Rudwaleit M, Khan MA, Braun J. 2006; Concepts and epidemiology of spondyloarthritis. Best Pract Res Clin Rheumatol. 20:401–17. DOI: 10.1016/j.berh.2006.02.001. PMID: 16777573.

2. Son CN, Choi G, Lee SY, Lee JM, Lee TH, Jeong HJ, et al. 2015; Sleep quality in rheumatoid arthritis, and its association with disease activity in a Korean population. Korean J Intern Med. 30:384–90. DOI: 10.3904/kjim.2015.30.3.384. PMID: 25995669. PMCID: PMC4438293.

3. Jeong HJ, Lee TH, Lee JM, Choi G, Son CN, Kim JM, et al. 2014; Sleep disturbances in Korean patients with ankylosing spondylitis are associated with increased disease activity. J Rheum Dis. 21:241–7. DOI: 10.4078/jrd.2014.21.5.241.

4. Lee J, Kim SS, Jeong HJ, Son CN, Kim JM, Cho YW, et al. 2017; Association of sleep quality in Behcet disease with disease activity, depression, and quality of life in Korean population. Korean J Intern Med. 32:352–9. DOI: 10.3904/kjim.2016.367. PMID: 28192886. PMCID: PMC5339476.

5. Leverment S, Clarke E, Wadeley A, Sengupta R. 2017; Prevalence and factors associated with disturbed sleep in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review. Rheumatol Int. 37:257–71. DOI: 10.1007/s00296-016-3589-x. PMID: 27796520.

6. Li Z, Fu T, Wang Y, Dong C, Shao X, Li L, et al. 2019; Sleep disturbances in ankylosing spondylitis: a systematic review and meta-analysis. Psychol Health Med. 24:911–24. DOI: 10.1080/13548506.2019.1574357. PMID: 31012756.

7. Koo BS, Oh JS, Park SY, Shin JH, Ahn GY, Lee S, et al. 2020; Tumour necrosis factor inhibitors slow radiographic progression in patients with ankylosing spondylitis: 18-year real-world evidence. Ann Rheum Dis. 79:1327–32. DOI: 10.1136/annrheumdis-2019-216741. PMID: 32660979.

8. Kiltz U, Braun J. 2020; Assessments of functioning in patients with axial spondyloarthritis. J Rheum Dis. 27:22–9. DOI: 10.4078/jrd.2020.27.1.22.

9. van der Linden S, Valkenburg HA, Cats A. 1984; Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 27:361–8. DOI: 10.1002/art.1780270401. PMID: 6231933.

10. Sohn SI, Kim DH, Lee MY, Cho YW. 2012; The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep Breath. 16:803–12. DOI: 10.1007/s11325-011-0579-9. PMID: 21901299.

11. Cho YW, Song ML, Morin CM. 2014; Validation of a Korean version of the insomnia severity index. J Clin Neurol. 10:210–5. DOI: 10.3988/jcn.2014.10.3.210. PMID: 25045373. PMCID: PMC4101097.

12. Cho YW, Lee JH, Son HK, Lee SH, Shin C, Johns MW. 2011; The reliability and validity of the Korean version of the Epworth sleepiness scale. Sleep Breath. 15:377–84. DOI: 10.1007/s11325-010-0343-6. PMID: 20358406.

13. Lim SY, Lee EJ, Jeong SW, Kim HC, Jeong CH, Jeon TY, et al. 2011; The validation study of Beck Depression Scale 2 in Korean version. Anxiety Mood. 7:48–53.

14. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. 1994; A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 21:2286–91. PMID: 7699630.

15. Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J, et al. 2009; Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 68:18–24. DOI: 10.1136/ard.2008.094870. PMID: 18625618.

16. Cohen JD, Cunin P, Farrenq V, Oniankitan O, Carton L, Chevalier X, et al. 2006; Estimation of the Bath Ankylosing Spondylitis Disease Activity Index cutoff for perceived symptom relief in patients with spondyloarthropathies. J Rheumatol. 33:79–81. PMID: 16395754.

17. Machado P, Landewé R, Lie E, Kvien TK, Braun J, Baker D, et al. 2011; Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. 70:47–53. DOI: 10.1136/ard.2010.138594. PMID: 21068095.

18. Assefa SZ, Diaz-Abad M, Wickwire EM, Scharf SM. 2015; The functions of sleep. AIMS Neurosci. 2:155–71. DOI: 10.3934/Neuroscience.2015.3.155.

19. Zielinski MR, McKenna JT, McCarley RW. 2016; Functions and mechanisms of sleep. AIMS Neurosci. 3:67–104. DOI: 10.3934/Neuroscience.2016.1.67. PMID: 28413828. PMCID: PMC5390528.

20. Da Costa D, Zummer M, Fitzcharles MA. 2009; Determinants of sleep problems in patients with spondyloarthropathy. Musculoskeletal Care. 7:143–61. DOI: 10.1002/msc.155. PMID: 19422064.

21. Nie A, Wang C, Song Y, Xie X, Yang H, Chen H. 2018; Prevalence and factors associated with disturbed sleep in outpatients with ankylosing spondylitis. Clin Rheumatol. 37:2161–8. DOI: 10.1007/s10067-018-4190-3. PMID: 29971585.

22. Wadeley A, Clarke E, Leverment S, Sengupta R. 2018; Sleep in ankylosing spondylitis and non-radiographic axial spondyloarthritis: associations with disease activity, gender and mood. Clin Rheumatol. 37:1045–52. DOI: 10.1007/s10067-018-3984-7. PMID: 29350332.

23. Urkmez B, Keskin Y. 2020; Relationship between sleep quality and physical activity level in patients with ankylosing spondylitis. Mod Rheumatol. 30:1053–9. DOI: 10.1080/14397595.2019.1702139. PMID: 31810412.

24. Batmaz İ, Sarıyıldız MA, Dilek B, Bez Y, Karakoç M, Çevik R. 2013; Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatol Int. 33:1039–45. DOI: 10.1007/s00296-012-2513-2. PMID: 22940709.

25. Missaoui B, Revel M. 2006; Fatigue in ankylosing spondylitis. Ann Readapt Med Phys. 49:305–8. DOI: 10.1016/j.annrmp.2006.03.007. PMID: 16780989.

26. Günaydin R, Göksel Karatepe A, Ceşmeli N, Kaya T. 2009; Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance. Clin Rheumatol. 28:1045–51. DOI: 10.1007/s10067-009-1204-1. PMID: 19504231.

27. Aissaoui N, Rostom S, Hakkou J, Berrada Ghziouel K, Bahiri R, Abouqal R, et al. 2012; Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance. Rheumatol Int. 32:2117–24. DOI: 10.1007/s00296-011-1928-5. PMID: 21516494.

28. Zhou W, Guo J, He M, Li J, Chen Y, Liu J, et al. 2020; Fatigue and contributing factors in Chinese patients with ankylosing spondylitis. Clin Rheumatol. 39:2337–44. DOI: 10.1007/s10067-020-04976-x. PMID: 32133565.