PO:27:105 | Sleep disturbances in patients with polymyalgia rheumatica: correlations with disease activity, fatigue, and glucocorticoid dosage

Ilaria Franch¹, Lorenzo Di Sanzo¹, Chiara Castellani², Giulia Bevignani¹, Lucia Colella¹, Veronica Alò¹, Fabrizio Conti¹, Rossana Scrivo¹ | ¹Università La Sapienza, Roma; ²Ospedale San Camillo De Lellis, Rieti, Italy

Background. The aim of this study was to investigate the prevalence of sleep disturbances in patients with polymyalgia rheumatica (PMR) and to assess their possible correlation with disease activity, fatigue, and glucocorticoid (GC) dosage.

Materials and Methods. Consecutive patients with PMR classified according to the 2012 ACR/EULAR provisional criteria and age- and sex-matched non-rheumatologic controls were enrolled. Demographic, clinical, and serological data, disease activity (PMR-activity score, PMR-AS, calculated using CRP); and current GC dose were recorded for all PMR patients. Both PMR patients and controls filled out questionnaires about their sleep quality and fatigue. These included the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Fatigue Severity Scale (FSS). Patients taking GC for conditions apart from PMR were excluded. Results are expressed as median/interquartile range (IQR). The χ² test, or Fisher’s exact test, was used for the comparison of categorical variables, as appropriate. Correlations were assessed using Spearman’s rank correlation coefficient. A p-value <0.05 was considered statistically significant.

Results. A total of 42 PMR patients (M/F 13/29, age 74.5 years [IQR 12.75], disease duration 6 months [IQR 8], ESR 18 mm/h [IQR 23.75], CRP 0.49 mg/dL [IQR 0.94], PMR-AS 1.085 [IQR 3.09], GC dose 5 mg/day prednisone equivalent [IQR 2.5]) and 42 controls (M/F 20/22, age 67 years [IQR 9.75]) were included (Table 1). Questionnaire adherence was 84% among PMR patients (42/50 respondents) and 100% among controls. Six PMR patients (14.2%) were taking hypnotic medications. The prevalence of sleep disturbances assessed by PSQI was 45% in PMR patients vs. 21% in controls (p<0.05). The prevalence of insomnia, evaluated by ISI, was 38% in PMR patients vs. 28% in controls (p=ns). Daytime sleepiness assessed by ESS was 0% in PMR patients vs. 7% in controls (p=ns). Fatigue prevalence was 17% in patients vs. 2% in controls (p<0.05). Significant correlations were observed between PSQI and ISI scores and GC dosage (r=0.316, p=0.041 and r=0.323, p=0.037, respectively) (Table 2).

Conclusions. In patients with PMR, the prevalence of sleep disturbances and fatigue was significantly higher than in controls, despite the use of hypnotics in some cases. Moreover, the correlation between sleep disturbances, fatigue, and GC use suggests a possible additional adverse effect of glucocorticoids—often overlooked but potentially detrimental to patients’ quality of life.