Barış GÜNDOĞDU, Süleyman Serdar KOCA, Ahmet YILDIRIM, Servet YOLBAŞ, Metin ÖZGEN, Deccane DÜZENCİ

Sleep quality, sleeping postures, and sleeping equipment in patients with ankylosing spondylitis

Background/aim: Inflammatory back pain, spinal stiffness, and limited spinal mobility are characteristic features of ankylosing spondylitis (AS). Sleeping postures can affect and/or reflect sleeping disturbances. The aim of the study was to evaluate sleeping postures and sleep disturbances in patients with AS. Materials and methods: Seventy-seven patients with AS and 49 healthy controls were enrolled. The Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) were applied to both groups. The most common sleeping postures were noted. Results: There was no significant difference between the groups in terms of sleeping postures. Total PSQI and ISI scores were higher in the AS group than in the controls (P = 0.004 and P = 0.038, respectively). The selection of sleeping postures of active and inactive patients were similar. The number of pillows used was not the same in the AS and control groups (P = 0.016). The frequency of customized bed use was higher in the AS group compared to the control group (P = 0.004). Conclusion: Sleep disturbances are more of a problem in patients with AS compared to healthy patients and in active AS patients compared to inactive ones. However, sleeping postures do not seem to affect either sleep disturbances or disease activity in patients with AS.

PDF

___

1. Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007; 369: 1379-1390.
2. Zammit GK. The prevalence, morbidities, and treatments of insomnia. CNS Neurol Disord-Dr 2007; 6: 3-16.
3. Da Costa D, Zummer M, Fitzcharles MA. Determinants of sleep problems in patients with spondyloarthropathy. Musculoskeletal Care 2009; 7: 143-161.
4. Hultgren S, Broman JE, Gudbjörnsson B, Hetta J, Lindqvist U. Sleep disturbances in outpatients with ankylosing spondylitis - a questionnaire study with gender implications. Scand J Rheumatol 2000; 29: 365-369.
5. Abad VC, Sarinas PSA, Guilleminault G. Sleep and rheumatologic disorders. Sleep Med Rev 2008; 12: 211-222.
6. Roizenblatt M, Rosa Neto NS, Tufik S, Roizenblatt S. Painrelated diseases and sleep disorders. Braz J Med Biol Res 2012; 45: 792-798.
7. Moldofsky H. Rheumatic manifestations of sleep disorders. Curr Opin Rheumatol 2010; 22: 59-63.
8. Batmaz İ, Sarıyıldız MA, Dilek B, Bez Y, Karakoç M, Çevik R. Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatol Int 2013; 33: 1039-1045.
9. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med 2007; 3: 7-10.
10. Aissaoui N, Rostom S, Hakkou J, Berrada Ghziouel K, Bahiri R, Abouqal R, Hajjaj-Hassouni N. Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance. Rheumatol Int 2012; 32: 2117-2124.
11. Solak O, Fidan F, Dündar U, Türel A, Ayçiçek A, Kavuncu V, Unlü M. The prevalence of obstructive sleep apnoea syndrome in ankylosing spondylitis patients. Rheumatology 2009; 48: 433-435.
12. 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: R215.
13. Karadağ O, Nakas D, Kalyoncu U, Akdoğan A, Kiraz S, Ertenli I. Effect of anti-TNF treatment on sleep problems in ankylosing spondylitis. Rheumatol Int 2012; 32: 1909-1913.
14. Oksenberg A, Dynia A, Nasser K, Gadoth N. Obstructive sleep apnoea in adults: body postures and weight changes interactions. J Sleep Res 2012; 21: 402-409.
15. Mador MJ, Choi Y, Bhat A, Dmochowski J, Braun M, Gottumukkala VA, Grant BJ. Are the adverse effects of body position in patients with obstructive sleep apnea dependent on sleep stage? Sleep Breath 2010; 14: 13-17.
16. Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 1999; 94: 2069-2073.
17. Gordon SJ, Grimmer-Somers K, Trott PH. Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Ther 2009; 14: 671-678.
18. Gordon SJ, Grimmer-Somers KA, Trott PH. Pillow use: the behavior of cervical stiffness, headache and scapular/arm pain. J Pain Res 2010; 3: 137-145.
19. Gordon SJ, Grimmer-Somers KA, Trott PH. A randomized, comparative trial: does pillow type alter cervico-thoracic spinal posture when side lying? Journal of Multidisciplinary Healthcare 2011; 4: 321-327.
20. Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361-368.
21. Garret S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21: 2286-2291.
22. Calin A, Garrett S, Whitelock H, Kennedy LG, OHea J, Mallorie P, Jenkinson T. A new approach to defining functional ability in ankylosing spondylitis the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994; 21: 2281-2285.
23. Jenkinson TR, Mallorie PA, Whitelock H, Kennedy LG, Garrett S, Calin A. Defining spinal mobility in ankylosing spondylitis: the Bath Ankylosing Spondylitis Metrology Index. J Rheumatol 1994; 21: 1694-1698.
24. MacKay K, Mack C, Brophy S, Calin A. The Bath Ankylosing Spondylitis Radiology Index (BASRI): a new, validated approach to disease assessment. Arthritis Rheum 1998; 41: 2263-2270.
25. Kucukdeveci AA, Sahin H, Ataman S, Griffiths B, Tennant A. Issues in cross-cultural validity: example from the adaptation, reliability and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Care Res 2004; 51: 14-19.
26. Doward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ, McKenna SP, Tennant A, van der Heijde D, Chamberlain MA. Development of ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 2003; 62: 20-26.
27. Duruöz MT, Doward L, Turan Y, Cerrahoglu L, Yurtkuran M, Calis M, Tas N, Ozgocmen S, Yoleri O, Durmaz B et al. Validity and reliability of the Turkish version of the Ankylosing Spondylitis Quality of Life (ASQoL) scale. Rheumatol Int 2013; 33: 2717-2722.
28. Aydemir Ö, Güvenir T, Küey L, Kültür S. Validity and reliability of Turkish version of hospital anxiety and depression scale. Turk Psikiyatri Derg 1997; 8: 280-287 (in Turkish with abstract in English).
29. Ağargün MY, Kara H, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatri Derg 1996; 7: 107-115 (in Turkish with abstract in English).
30. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001; 2: 297-307.
31. Hsia CC, Liou KJ, Aung AP, Foo V, Huang W, Biswas J. Analysis and comparison of sleeping posture classification methods using pressure sensitive bed system. Conf Proc IEEE Eng Med Biol Soc 2009; 2009: 6131-6134.
32. Wai AAP, Foo SF, Huang W, Biswas J, Hsia CC, Liou K, Yap P. Lying posture classification for pressure ulcer prevention. Journal of Healthcare Engineering 2010; 1: 217-238.
33. Gordon S, Grimmer K, Trott P. Sleep position, age, gender, sleep quality and waking cervico-thoracic symptoms. Internet Journal of Allied Health Sciences and Practice 2007; 5: 1-12.
34. Lee YC, Chibnik LB, Lu B, Wasan AD, Edwards RR, Fossel AH, Helfgott SM, Solomon DH, Clauw DJ, Karlson EW. The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2009; 11: R160.
35. Heiberg T, Lie E, van der Heijde D, Kvien TK. Sleep problems are of higher priority for improvement for patients with ankylosing spondylitis than for patients with other inflammatory arthropathies. Ann Rheum Dis 2011; 70: 872- 873.
36. Rudwaleit M, Gooch K, Michel B, Herold M, Thörner A, Wong R, Kron M, Chen N, Kupper H. Adalimumab improves sleep and sleep quality in patients with active ankylosing spondylitis. J Rheumatol 2011; 38: 79-86.
37. Joosten SA, ODriscoll DM, Berger PJ, Hamilton GS. Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep Med Rev 2014; 18: 7-17.
38. Tiotiu A, Mairesse O, Hoffmann G, Todea D, Noseda A. Body position and breathing abnormalities during sleep: a systematic study. Pneumologia 2011; 60: 216-221.
39. Wong MH, Lai AH, Singh M, Chew PT. Sleeping posture and intraocular pressure. Singap Med J 2013; 54: 146-148.
40. Gordon S1, Grimmer-Somers KA, Trott PH Pillow use: the behavior of cervical stiffness, headache and scapular/arm pain. J Pain Res 2010; 3: 137-145.