Prevalence of sleep disturbance in patients with ankylosing spondylitis: a systematic review and meta-analysis

Salari, Nader; Sadeghi, Narges; Hosseinian-Far, Amin; Hasheminezhad, Razie; Khazaie, Habibolah; Shohaimi, Shamarina; Mohammadi, Masoud

doi:10.1186/s42358-023-00315-1

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Research • Adv. rheumatol. 63 • 2023 • https://doi.org/10.1186/s42358-023-00315-1 copy

Prevalence of sleep disturbance in patients with ankylosing spondylitis: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Ankylosing Spondylitis (AS) patients face several challenges due to the nature of the disease and its physical and psychological complications. Sleep disorders are among the most important concerns. Sleep disorders can aggravate the signs and symptoms of the disease and ultimately reduce the quality of patients’ lives. This study uses a systematic review and meta-analysis to pool the reported prevalence of sleep disorders among AS patients.

Methods

To find related studies, the WoS, PubMed, ScienceDirect, Scopus, Embase, and Google Scholar databases were systematically searched without a lower time limit. Heterogeneity among the identified studies was checked using the I² index, and the Begg and Mazumdar correlation test examined the existence of published bias. Comprehensive Meta-Analysis (v.2) software was adopted to analyze the data.

Results

In the review of 18 studies with a sample size of 5,840, the overall pooled prevalence of sleep disorders among AS patients based on the random effects method was found to be 53% (95% CI: 44.9–61). The highest and lowest prevalence was in Egypt at 90% and Australia at 19.2%, respectively. Our meta-regression results show that with the increase in ‘sample size’ and ‘year of publication’, the overall prevalence of sleep disorders in patients with AS decreases (p < 0.05).

Conclusion

The results of the present study indicate a high and significant prevalence of sleep disorders among AS patients. Thus, health policymakers and healthcare providers must focus on timely diagnosis and effective educational and therapeutic interventions for the prevention and proper treatment of sleep disorders in this population of patients.

Keywords
Ankylosing Spondylitis; Sleep disturbance; Prevalence; Meta-analysis

Author	Year	Country	Type of study	AS diagnostic criteria	sleep disturbance measurement tool	Age	Sample size	Prevalence (%)
Abdulaziez and Asaad(¹⁹19 Abdulaziez O, Asaad T. Sleep problems in ankylosing spondylitis: polysomnographic pattern and disease related variables. Egypt Rheumatologist. 2012;34(2):59–65.)	2012	Egypt	Cross-sectional study	modified New York classification criteria for AS	PSQI	37.8±5.6	20	90
Aissaoui et al(³⁴34 Aissaoui N, Rostom S, Hakkou J, Berrada Ghziouel K, Bahiri R, Abouqal R, et al. Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance. Rheumatol Int. 2012;32(7):2117–24.)	2012	Morocco	Cross-sectional study	modified New York classification criteria for AS	fourth item of Hamilton anxiety scale	38.52±12.62	110	64.5
Batmaz et al(²⁸28 Batmaz I, Sariyildiz MA, Dilek B, Bez Y, Karakoc M, Cevik R. Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatol Int. 2013;33(4):1039–45.)	2013	Turkey	Cross-sectional study	modified New York classification criteria for AS	PSQI	35.3±6.7 (16–60)	80	50
Chen et al(⁶6 Chen CH, Chen HA, Liao HT, Chen CH. Association of sleep disturbance with calcitonin, disease severity and health index among patients with ankylosing spondylitis. Medicine. 2021;100:32.)	2021	Taiwan	Cross-sectional study	modified New York classification criteria for AS	19th item of PSQI	45.981±12.157	104	36.5
Demirci et al(¹⁴14 Demirci S, Demirci K, Dogru A, Inal EE, Koyuncuoglu HR, Sahin M. Restless legs syndrome is associated with poor sleep quality and quality of life in patients with ankylosing spondylitis: a questionnaire-based study. Acta Neurol Belgica. 2016;116(3):329–36.)	2016	Turkey	Cross-sectional study	modified New York classification criteria for AS	PSQI	41 (median)	108	64.8
Günaydin et al(²⁷27 Günaydin R, Göksel Karatepe A, Ceşmeli N, Kaya T. Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance. Clin Rheumatol. 2009;28(9):1045–51.)	2009	Turkey	Cross-sectional study	modified New York classification criteria for AS	PSQI	39.6±10.3	62	54.8
Hakkou et al(22)	2013	Morocco	Cross-sectional study	modified New York classification criteria for AS	fourth item of Hamilton anxiety scale	38.5±12.6	110	64.5
Hultgren et al(³⁵35 Hultgren S, Broman JE, Gudbjornsson B, Hetta J, Lindqvist U. Sleep disturbances in outpatients with ankylosing spondylitis - a questionnaire study with gender implications. Scand J Rheumatol. 2000;29(6):365–9.)	2000	Sweden	Cross-sectional study	modified New York classification criteria for AS	USI		70	62
Jiang et al1(¹⁶16 Jiang Y, Yang M, Lv Q, Qi J, Lin Z, Liao Z, et al. Prevalence of psychological disorders, sleep disturbance and stressful life events and their relationships with disease parameters in chinese patients with ankylosing spondylitis. Clin Rheumatol. 2018;37(2):407–14.)	2018	China	Cross-sectional study	modified New York classification criteria for AS	PSQI	28.99±8.87	2772	31
Jiang et al2(³⁶36 Jiang Y, Yang M, Wu H, Song H, Zhan F, Liu S, et al. The relationship between disease activity measured by the BASDAI and psychological status, stressful life events, and sleep quality in ankylosing spondylitis. Clin Rheumatol. 2015;34(3):503–10.)	2015	China	Cross-sectional study	modified New York classification criteria for AS	PSQI	27.33±8.67	683	37.3
Karatas et al(³⁷37 Karatas G, Bal A, Yuceege M, Firat H, Gurcay E, Ardic S, et al. Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti-TNF-therapy on sleep problems: a polisomnographic study. Int J Rheum Dis. 2018;21(6):1263–9.)	2018	Turkey	Prospective study	modified New York classification criteria for AS	PSQI	37.39±8.01 (18–75)	34	57.9
Li et al(³⁸38 Li Y, Zhang S, Zhu J, Du X, Huang F. Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study. Arthritis Res Ther. 2012;14(5):R215.)	2012	China	Case-control study	modified New York classification criteria for AS	PSQI	27.65±8.34	314	35.4
Nie et al(²⁰20 Nie A, Wang C, Song Y, Xie X, Yang H, Chen H. Prevalence and factors associated with disturbed sleep in outpatients with ankylosing spondylitis. Clin Rheumatol. 2018;37(8):2161–8.)	2018	China	Cross-sectional study	modified New York classification criteria for AS	PSQI	31.71±9.80 (14–61)	281	67.6
Song et al1(³⁹39 Song BW, Jeong HJ, Kim BY, Cho YW, Son CN, Kim SS, et al. Bath Ankylosing Spondylitis Disease Activity Index is Associated with the quality of Sleep in Ankylosing Spondylitis Patients. J Rheumatic Dis. 2021;28(3):143–9.)	2021	Korea	Cross-sectional study	modified New York classification criteria for AS	PSQI	35.81±11.78	107	65.4
Song et al2(⁴⁰40 Song Y, Wang C, Chen H. Functional limitation and associated factors in outpatients with ankylosing spondylitis in Southwest China. Clin Rheumatol. 2017;36(4):871–7.)	2017	China	Cross-sectional study	modified New York classification criteria for AS	PSQI	31.66±9.69	295	49.3
Tymms et al(¹⁰10 Tymms K, Butcher BE, Sletten TL, Smith T, O'Sullivan C, Littlejohn G, et al. Prevalence of sleep disturbance and the association between poor disease control in people with ankylosing spondylitis within the australian clinical setting (ASLEEP study): a real-world observational study using the OPAL dataset. Clin Rheumatol. 2022;41(4):1105–14.)	2022	Australia	Retrospective cross-sectional study	ICD code M45, M45.0 or M08.1	ISI	48.3±13.6 (18–95)	495	19.2
Ward(⁴¹41 Ward MM. Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res. 1999;12(4):247–55.)	1999	United States of America	Cross-sectional study	modified New York classification criteria for AS	One of items of a 23-item questionnaire which assesses 23 aspects of health-related quality of life and was validated in this study and used in some previous studies	51.1±14.0	175	54.1
Yüksel et al(⁴²42 Yüksel GA, Kurtuluş D, Tireli H. Sleep quality and restless legs syndrome in patients with ankylosing spondylitis. Med J Haydarpaşa Numune Train Res Hosp. 2019;59(1):78–83.)	2019	Turkey	Cross-sectional study	modified New York classification criteria for AS	PSQI	39.6±11.3 (21–56)	20	80

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[1] *Correspondence: Masoud Mohammadi, Masoud.mohammadi1989@yahoo.com