Monitoring of Sleep Indicators, Physical Activity, Pain, and Fatigue in Patients with Systemic Lupus Erythematosus and Relations among These Variables: A Pilot Study
Background: Poor sleep, fatigue, and pain are major health problems in patients with systemic lupus erythematosus (SLE). However, only cross-sectional surveys on these health outcomes have been conducted, and the association between day-to-day fluctuations remains unknown. Objectives: We aimed to characterize daily fluctuations in sleep quality, physical activity, pain, and fatigue in patients with SLE. Method: Exploratory study with a cross-sectional design. Two rheumatology centers (a university hospital and a prefectural hospital) in Japan between September 2017 and May 2019. The sample size was set to 20. Demographic and clinical data were collected. Sleep and physical activity were measured with monitoring devices; pain and fatigue levels were recorded daily during the 4-week period. The Pittsburgh Sleep Quality Index, Short Form Health Survey-12, the Japanese version of the Lupus Patient Outcome, and SLE Disease Activity Index 2000 were collected at the start and end of the study. Descriptive statistics and coefficients of variation (CV) were tabulated to examine daily fluctuations. Pearson correlation coefficients were obtained for monitored variables. Results: The mean age was 43.7 ± 8.5 years, and the mean SLE duration was 16.0 ± 7.2 years. The mean moderate-to-vigorous physical activity (MVPA) duration was 7.8 ± 5.8 min/day, and the mean total sleep duration was 391.8 ± 65.3 min, with a mean sleep efficiency of 88.6% ± 6.1%. Daily fluctuations were high for leaving the bed frequency, MVPA duration, pain, and waking after sleep onset. Seventeen participants showed correlations between some of the variables, such as fatigue or longer MVPA duration and poorer sleep outcomes; longer sleep latency and increased frequency of leaving the bed; and higher physical activity and increased pain and fatigue. Conclusion: The quality of sleep and fatigue fluctuated daily, and correlations existed between these variables, as well as for pain and physical activity. The impact of MVPA duration on pain and fatigue is of concern as increased physical activity may worsen the quality of life patients with SLE. The monitoring of sleep and physical activity using the device seems feasible for SLE symptom management.
References
[1]
Mertz, P., Schlencke, A., Schneider, M., et al. (2020) Towards a Practical Management of Fatigue in Systemic Lupus Erythematosus. Lupus Science and Medicine, 7, e000441. https://doi.org/10.1136/lupus-2020-000441
[2]
Vina, E.R., Green, S.L., Trivedi, T., et al. (2013) Correlates of Sleep Abnormalities in Systemic Lupus Erythematosus in an Urban, Academic Center. Journal of Clinical Rheumatology, 19, 7-13. https://doi.org/10.1097/RHU.0b013e31827cd20d
[3]
Inoue, M., Shiozawa, K., Yoshihara, R., et al. (2017) Predictors of Poor Sleep Quality in Patients with Systemic Lupus Erythematosus. Clinical Rheumatology, 36, 1053-1062. https://doi.org/10.1007/s10067-017-3545-5
[4]
Kauka, L., Schlencker, A., Mertz, P., et al. (2021) Fatigue in Systemic Lupus Erythematosus: An Update on Its Impact, Determinants and Therapeutic Management. Journal of Clinical Medicine, 10, 3996. https://doi.org/10.3390/jcm10173996
[5]
Özer, S., Kankaya, H., Gün, R., et al. (2022) Factors Affecting Sleep Quality in Patients with Systemic Lupus Erythematosus. Lupus, 31, 39-44. https://doi.org/10.1177/09612033211062521
[6]
Balderas, D., Martínez, M.P., Guerrero, C., et al. (2017) Using Actigraphy and mHealth Systems for an Objective Analysis of Sleep Quality on Systemic Lupus Erythematosus Patients. Methods of Information in Medicine, 56, 171-179. https://doi.org/10.3414/ME16-02-0011
[7]
Cervilla, O., Miró, E., Martínez, M.P., et al. (2020) Sleep Quality and Clinical and Psychological Manifestations in Women with Mild Systemic Lupus Erythematosus Activity Compared to Women with Fibromyalgia: A Preliminary Study. Modern Rheumatology, 30, 1016-1024. https://doi.org/10.1080/14397595.2019.1679973
[8]
Dey, M., Parodis, I. and Nikiphorou, E. (2021) Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management. Journal of Clinical Medicine, 10, 3566. https://doi.org/10.3390/jcm10163566
[9]
Barbacki, A., Petri, M., Avina-Zubiets, A., et al. (2019) Fatigue Measurements in Systemic Lupus Erythematosus. Journal of Rheumatology, 46, 1470-1477. https://doi.org/10.3899/jrheum.180831
[10]
Sivakumaran, J., Harvey, P., Omar, A., et al. (2018) Assessment of Cardiovascular Risk Tools as Predictors of Cardiovascular Disease Events in Systemic Lupus Erythematosus. Lupus Science and Medicine, 8, e000448. https://doi.org/10.1136/lupus-2020-000448
[11]
Wu, M.L., Tsai, J.C., Yu, K.H., et al. (2019) Effects of Physical Activity Counselling in Women with Systemic Lupus Erythematosus: A Randomized Controlled Trial. International Journal of Nursing Practice, 25, e12770. https://doi.org/10.1111/ijn.12770
[12]
Youssef, M.K. (2019) Effect of Exercises Training on Fatigue, Depression and Physical Activity in Patients with Systemic Lupus Erythematosus. Journal of Health and Medical Research, 1, 4-11.
[13]
Blanca, G.C., Jose A.V.H., Pablo M.L., et al. (2022) Effects of 12-Week Aerobic Exercise on Patient-Reported Outcomes in Women with Systemic Lupus Erythematosus. Disability and Rehabilitation, 44, 1863-1871. https://doi.org/10.1080/09638288.2020.1808904
[14]
Mahieu, M.A., Ahn, G.E., Chmiel, J.S., et al. (2016) Fatigue, Patient Reported Outcomes, and Objective Measurement of Physical Activity in Systemic Lupus Erythematosus. Lupus, 25, 1190-1199. https://doi.org/10.1177/0961203316631632
[15]
Pablo, M.L., Josè A.V.H., Antonia, R.C., et al. (2018) Association of Objectively Measured Physical Activity and Sedentary Time with Arterial Stiffness in Women with Systemic Lupus Erythematosus with Mild Disease Activity. PLOS ONE, 13, e0196111. https://doi.org/10.1371/journal.pone.0196111
[16]
Legge, A., Blanchard, C., Hanly, J.G., et al. (2018) Physical Activity and Sedentary Behavior in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis. Open Access Rheumatology, 13, 191-200. https://doi.org/10.2147/OARRR.S148376
[17]
Margiotta, D.P.E., Basta, F., Dolcini, G., et al. (2018) Physical Activity and Sedentary Behavior in Patients with Systemic Lupus Erythematosus. PLOS ONE, 13, e0193728. https://doi.org/10.1371/journal.pone.0193728
[18]
Bağlan, Y.S., Karatay, S., Oskay, D., et al. (2019) Kinesiophobia and Related Factors in Systemic Lupus Erythematosus Patients. Turkish Journal of Medical Sciences, 49, 1324-1331. https://doi.org/10.3906/sag-1804-152
[19]
Chaput, J.P., Dutil, C., Featherstone, R., et al. (2020) Sleep Timing, Sleep Consistency, and Health in Adults: A Systematic Review. Applied Physiology, Nutrition, and Metabolism, 45, S232-S247. https://doi.org/10.1139/apnm-2020-0032
[20]
Julious, S.A. (2005) Sample Size of 12 per Group Rule of Thumb for a Pilot Study. Pharmaceutical Statistics, 4, 287-291. https://doi.org/10.1002/pst.185
[21]
Kogure, T., Shirakawa, S., Shimokawa, M., et al. (2011) Automatic Sleep/Wake Scoring from Body Motion in Bed: Validation of a Newly Developed Sensor Placed under a Mattress. Journal of Physiological Anthropology, 30, 103-109. https://doi.org/10.2114/jpa2.30.103
[22]
Kogure, T. and Ebata, T. (2018) Activity during Sleep Measured by a Shaped Body Vibrometer and the Severity of Atopic Dermatitis in Adult: A Comparison with wrist Actigraphy. Journal of Clinical Sleep Medicine, 14, 199-204. https://doi.org/10.5664/jcsm.6932
[23]
Murayama, R., Abe-Doi, M., Kogre, T., et al. (2021) The Influence of Peripheral Intravenous Catheterization on the Sleep Quality of Ophthalmic Inpatients: An Observational Study. Journal of Nursing Science and Engineering, 8, 134-142.
[24]
Buysse, D., Reynolds, C.F., 3rd Monk, T.H., et al. (1989) The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric and Research. Psychiatry Research, 28, 193-213. https://doi.org/10.1016/0165-1781(89)90047-4
[25]
Inoue, M., Shiozawa, K., Yoshihara, R., et al. (2017) The Japanese LupusPRO: A Cross-Cultural Validation of an Outcome Measure for Lupus. Lupus, 26, 849-856. https://doi.org/10.1177/0961203316682100
[26]
Ware, J., Kosinki, M. and Keller, S.D. (1996) A 12-Item Short-Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity. Medical Care, 34, 220-233. https://doi.org/10.1097/00005650-199603000-00003
[27]
Karlson, E.W., Liang, M.H., Eaton, H., et al. (2004) A Randomized Clinical Trial of a Psychoeducational Intervention to Improve Outcomes in Systemic Lupus Erythematosus. Arthritis and Rheumatology, 50, 1832-1841. https://doi.org/10.1002/art.20279
[28]
Reed, D.L. and Sacco, W.P. (2016) Measuring Sleep Efficiency: What Should the Denominator Be? Journal of Clinical Sleep Medicine, 12, 263-266. https://doi.org/10.5664/jcsm.5498
[29]
Jung, D.W., Hwang, S.H., Chung, G.S., et al. (2013) Estimation of Sleep Onset Latency Based on the Blood Pressure Regulatory Reflex Mechanism. IEEE Journal of Biomedical and Health Informatics, 17, 534-544. https://doi.org/10.1109/JBHI.2013.2257816
[30]
Bull, F.C., Al-Ansari, S.S., Biddle, S., et al. (2020) World Health Organization 2020 Guidelines on Physical Activity and Sedentary Behavior. British Journal of Sports Medicine, 54, 1451-1462. https://doi.org/10.1136/bjsports-2020-102955
[31]
O’Dwyer, T., Durcan, L. and Wilson, F. (2017) Exercise and Physical Activity in Systemic Lupus Erythematosus: A Systematic Review with Meta-Analyses. Seminars in Arthritis and Rheumatism, 47, 204-215. https://doi.org/10.1016/j.semarthrit.2017.04.003
[32]
Chastin, S.F.M., Craemer, M.D., Cocker, K.D., et al. (2019) How Dose Light-Intensity Physical Activity Associate with Adult Cardiometabolic Health and Mortality? Systematic Review with Meta-Analysis of Experimental and Observational Studies. British Journal of Sports Medicine, 53, 370-376. https://doi.org/10.1136/bjsports-2017-097563
[33]
Amagasa, S., Machida, M., Fukushima, N., et al. (2018) Is Objectively Measured Light-Intensity Physical Activity Associated with Health Outcomes after Adjustment for Moderate-to-Vigorous Physical Activity in Adults? A Systemic Review. International Journal of Behavioral Nutrition and Physical Activity, 15, 65. https://doi.org/10.1186/s12966-018-0695-z
[34]
Cleanthous, S., Strzok, S., Haier, B., et al. (2022) The Patient Experience of Fatigue in Systemic Lupus Erythematosus: A Conceptual Model. Rheumatology and Therapy, 9, 95-108. https://doi.org/10.1007/s40744-021-00374-0
[35]
Kajimoto, O., Shiraichi, Y., Ohtsuka, M., et al. (2009) Effect of Continuous Use of Air-Conditioner with Coanda Airflow from Nighttime to the Next Daytime on Fatigue. Journal of the Japanese Physical Therapy Association, 15, 197-207. (In Japanese)
[36]
Shino, T., Gogure, T., Tsuchiya, M., et al. (2020) Effect of Automatic Back-Lowering by Electric Bed on Sleep. Journal of Science of Labour, 96, 1-8. (In Japanese)
[37]
Rijo-Ferreira, F. and Takahashi, J.S. (2019) Genomics of Circadian Rhythms in Health and Disease. Genome Medicine, 11, 82. https://doi.org/10.1186/s13073-019-0704-0
[38]
Costello, H.M. and Gumz, M. (2021) Circadian Rhythm, Clock Genes, and Hypertension: Recent Advances in Hypertension. Hypertension, 78, 1185-1196. https://doi.org/10.1161/HYPERTENSIONAHA.121.14519
[39]
Jahanban-Esfahlan, R., Mehrzadi, S., Reiter, R., et al. (2018) Melatonin in Regulation of Inflammatory Pathways in Rheumatoid Arthritis and Osteoarthritis: Involvement of Circadian Clock Genes. British Journal of Pharmacology, 175, 3230-3238. https://doi.org/10.1111/bph.13898
