Impaired Sleep Quality In Rheumatoid Arthritis Patients: New Evidence from a Systemic Review and Meta-Analysis Containing Both Subjective and Objective Studies

Objective: Emerging studies have suggested that patients with rheumatoid arthritis (RA) are usually accompanied with sleep disturbances, but the results are inconsistent. In this study, sleep disorders and influencing factors in RA patients were comprehensively studied by using both objective and subjective methods.Methods: Systematic search was conducted in PubMed, Embase and Cochrane databases up to July 24, 2021. The quality assessment of the included studies was based on the Newcastle-Ottawa Scale. The key data of qualified research were abstracted into a standard form for systematic evaluation. The data of all sleep parameters were extracted to standardized mean differences (SMD) with 95% confidence intervals (CI).Results: Thirty-three studies were reviewed in the qualitative synthesis, of which 29 met the inclusion criteria for the meta-analysis. Compared with controls, for 6 studies on objectively recorded sleep, patients with RA had lower total sleep time (SMD = - 0.48; 95% CI: - 0.76, - 0.20; P < 0.001), decreased sleep efficiency (SMD = -0.67; 95% CI: - 1.00, - 0.34; P < 0.001), prolonged sleep latency (SMD = 0.56; 95% CI: 0.19, 0.92; P < 0.001), higher wake time after sleep onset (SMD = 0.70; 95% CI: 0.33, 1.08; P < 0.001), and shortened non-rapid eye movement sleep (NREM) 2 (SMD = - 0.31; 95% CI: - 0.57, - 0.05; P = 0.020). Consistently, results from 26 subjective studies also showed poorer sleep quality in RA patients than in controls (SMD = 0.88; 95% CI: 0.66, 1.10; P < 0.001).Conclusion: Our comprehensive analysis containing both objective and subjective studies provides new evidence for impaired sleep quality in RA patients, it is necessary to pay close attention to the care and management of sleep problems in these patients.