Sleep Disturbance in Rheumatoid Arthritis: Phenotypes, Causes, and Impact

项目摘要/摘要 自我报告的睡眠问题在类风湿性关节炎(RA)中很常见，但客观测量的数据显示 睡眠不足。我们的初步数据提供了频繁自我报告睡眠问题的证据，存在 客观识别的睡眠障碍，以及这些睡眠障碍与糟糕的RA特异性之间的关联 健康结果。拟议的项目将解决围绕睡眠的重大知识差距。 拉斯维加斯的骚乱。该项目的目标是：(1)确定与睡眠障碍和变化相关的风险因素 在RA患者的睡眠障碍中；(2)确定短期和长期的纵向影响 睡眠障碍和睡眠障碍的变化对RA健康结局的影响；以及(3)检查生物学 类风湿性关节炎特有的途径解释类风湿性关节炎睡眠障碍的高患病率及其与类风湿性关节炎的关系 结果。之前没有研究试图将炎症生物标记物和皮质醇的破坏联系起来， 伴随着RA症状的高峰期，伴随着睡眠障碍或昼夜休息中断- 活动模式。150名RA患者将被登记，并在24个月内接受跟踪调查。基线，6-和12- 一个月的评估将包括7个晚上的活动监测，以衡量睡眠和昼夜休息- 活动模式；睡眠和症状日记的完成情况；评估疾病活动、疼痛、 疲劳、体力活动和抑郁症状；抽血检测炎症标志物；唾液 全天皮质醇收集。其他原发睡眠障碍的筛查将在基线上进行。后续行动 基线后18个月和24个月将继续监测睡眠和结局，并进行7个晚上的睡眠监测 通过活动记录和完成睡眠/症状日记和问卷调查。每两周一次的电话登记将 监测糖皮质激素(GC)和其他药物的使用、剂量和时机。创新型 拟议项目的组成部分包括客观的睡眠测量，对角色的详细检查 GCs在RA睡眠障碍中的作用，炎性和激素生物标志物的作用，以及 扩展的纵向评估，这将使人们能够检查睡眠的潜在相互影响 紊乱、炎症、皮质醇昼夜节律变化、类风湿关节炎症状和疾病活动性。这项研究 团队包括具有风湿学、睡眠、免疫学专业知识的研究人员的独特合作， 心理神经免疫学和统计学方法。数据将提供对预测者和机制的洞察 睡眠障碍的前兆，提供有关睡眠障碍对RA健康的影响的信息 结果，并为可能的干预措施提供初步证据。了解睡眠障碍的原因 RA很重要，因为RA疾病活动的评估以及关于使用、时机和 对RA治疗反应的评估，可能会受到并发睡眠问题的影响。更好地了解 类风湿性关节炎患者的睡眠障碍可能为设计和进行研究以改善治疗奠定基础 战略，这将最终改善类风湿关节炎患者的健康和生活质量。

Project Summary/Abstract Self-reported sleep problems are common in rheumatoid arthritis (RA), but objectively-measured data on sleep are lacking. Our preliminary data provide evidence of frequent self-reported sleep problems, existence of objectively-identified sleep disturbances, and the association of those sleep disturbances with poor RA-specific health outcomes. The proposed project will address the significant knowledge gaps surrounding sleep disturbances in RA. Project aims are to: (1) identify risk factors associated with sleep disturbance and changes in sleep disturbance in individuals with RA; (2) identify the short-term and longer-term longitudinal effects of sleep disturbance and changes in sleep disturbances on health outcomes in RA; and (3) examine a biological pathway unique to RA to explain the high prevalence of sleep disturbance in RA and associations with RA outcomes. No previous studies have attempted to link the disruptions in inflammatory biomarkers and cortisol, and the concomitant peaking of RA symptoms, with sleep disturbance or with disruption of circadian rest- activity patterns. 150 individuals with RA will be enrolled and followed over 24 months. Baseline, 6- and 12- month assessments will consist of 7-nights of actigraphy monitoring to measure sleep and circadian rest- activity patterns; completion of sleep and symptom diaries; questionnaires to assess disease activity, pain, fatigue, physical activity, and symptoms of depression; blood draws for inflammatory markers; and salivary diurnal cortisol collection. Screening for other primary sleep disorders will be conducted at baseline. Follow-ups 18 and 24 months after baseline will continue monitoring sleep and outcomes with 7 nights of sleep monitoring by actigraphy and completion of sleep/symptom diaries and questionnaires. Bi-weekly telephone check-ins will be conducted to monitor use, dosage, and timing of glucocorticoids (GCs) and other medications. Innovative components of the proposed project include objective measurements of sleep, detailed examination of the role of GCs in sleep disturbance in RA, examination of the roles of inflammatory and hormonal biomarkers, and the extended longitudinal assessments, which will permit examination of the potential reciprocal effects of sleep disturbance, inflammation, circadian variation in cortisol, and RA symptoms and disease activity. The study team includes a unique collaboration of investigators with expertise in rheumatology, sleep, immunology, psychoneuroimmunology, and statistical methods. Data will yield insights into predictors and mechanistic precursors of sleep disturbance, provide information regarding the impact of sleep disturbance on RA health outcomes, and provide preliminary evidence for potential interventions. Understanding sleep disturbances in RA is important because assessments of RA disease activity, as well as decisions on the use, timing and evaluation of response to RA therapy, may be impacted by concurrent sleep problems. Better understanding of sleep disturbances in RA may lay groundwork for design and conduct of studies to improve therapeutic strategies, which will ultimately improve health and quality of life of persons with RA.