Effect of COVID-19 pandemic on sleep disorders in patients with inflammatory arthritis

Ingegnoli, F.; Buoli, M.; Posio, C.; Di Taranto, R.; Caporali, R.

Background: A decrease in physical activity, exposure to daylight and a decline in psychological wellbeing due to COVID19 pandemic have led to increased incidence of sleep disorders such as difficulties falling asleep, sleep disruption, insomnia, nightmares and daytime sleepiness (1). Patients with inflammatory arthritis are more vulnerable to pain, depression, anxiety and sleep disorders. These complaints are linked in a cyclical pattern that may negatively affect daily-life activities (2-4). To our knowledge, the impact of pandemic on sleep disturbances in patients with inflammatory arthritis has not been evaluated yet. Objectives: The aim of this study is to establish the COVID-19 related impact on sleep disturbances among patients with inflammatory arthritis who experienced the COVID-19 quarantine in Italy. Methods: Data about chronic inflammatory arthritis (rheumatoid arthritis [RA], psoriatic arthritis [PsA] and ankylosing spondylitis [AS]) were retrieved from a large nationwide online survey involving patients affected by different rheumatic diseases. From May to September 2020, eleven patients' associations sent a call to rheumatic patients asking them to complete an anonymous online survey with specific questions also about sleep disturbances and pre-and post-lockdown self-reported use of psychopharmacotherapy. Data were analysed by a binary logistic regression model having the presence of sleep disturbances during COVID 19 pandemic as dependent variable. Results: 375 of 507 (74%) of patients had inflammatory arthritis: 249 RA, 77 PsA and 49 AS. 291 (77.6%) were females with a median (IQR) age of 54 (44-63) years. There was an increase in the use of psychiatric compounds after quarantine period (59 [15,7%] vs 65 [17,3%]), especially for sleep medications (23 [6,1%] vs 28 [7,5%]) and anxiolytics (15 [4%] vs 18 [4,8%]). 246 (65.6%) of patients had trouble staying asleep, 238 (63.5%) had trouble falling asleep, and 112 (29.9%) had dreams about pandemic (Figure 1 below). Conclusion: These results confirm that sleep disturbances have been a relevant concern in patients with inflammatory arthritis after COVID-19 national lockdown. Changes in daily life related to confinement have influenced psychological distress leading to a significant impact on sleep difficulties such as inability to fall early asleep or to maintain adequate sleep. Furthermore, older patients who had coronavirus infection and were previously treated for psychiatric disorders were at higher risk developing sleep disorders.