0915 Sleep in Rheumatoid Arthritis: A Systematic Review and Meta-analysis of Objective Sleep Parameters

Abstract

Objective sleep parameters in rheumatoid arthritis (RA) patients have been evaluated using various methods including polysomnography and actigraphy. We performed a comprehensive systematic review and meta-analysis of objective sleep data to investigate sleep dysfunction in RA patients and healthy controls.We performed a systematic search of Medline, Embase, CENTRAL, and PsycInfo databases from inception to December 2016. Studies reporting original polysomnography or actigraphy data for sleep assessment in adult patients with RA were included. Studies were screened by title and abstract, then full-text review by 2 independent reviewers. We extracted data and performed random effects meta-analysis for objective sleep parameters using the “R” statistical computing software.We identified 2733 articles for review with 20 studies meeting inclusion criteria (677 total patients), and 7 studies directly comparing RA patients (n=147) with healthy controls (n=121). For RA patients generally, random-effects meta-analysis revealed the following values (mean, (95% CI), [recommended]): Total Sleep Time (TST) 387.76 min (364.8, 410.7) [420–540 min], Sleep Latency 27.51 min (21.87, 33.15) [0–30 min], Wake-After-Sleep-Onset (WASO) 64.63 min (51.97, 77.29) [0–20 min], Sleep Efficiency 79.26% (74.45, 84.0) [85–100%], REM 16.65% (15.0, 18.3) [21–30%], Stage 1 sleep 10.17% (6.48, 13.87) [0–5%], Stage 2 sleep 48.37% (43.65, 53.09) [<81%], and Slow Wave sleep 13.98% (10.92, 17.04) [16–20%]. For studies comparing RA patients to healthy controls, meta-analysis revealed standardized mean differences of: Total Sleep Time -0.27 (-0.51, -0.03), Sleep Latency 0.37 (0.08, 0.66), WASO 0.56 (0.29, 0.84), Sleep Efficiency -0.57 (-0.85, -0.29), and REM % 0.12 (-0.19, 0.43).RA patients have worse than recommended measurements for TST, WASO, sleep efficiency, stage 1 and REM sleep. Additionally, when compared to healthy controls, RA patients have worse objective parameters with respect to total sleep time, sleep latency, WASO, and sleep efficiency. Therefore, clinicians should be cognizant of addressing sleep health when considering overall care and well-being among RA patients.None.