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Sleep in early rheumatoid arthritis patients

Sömn hos patienter med tidig reumatoid artrit


Responsible: Helga Westerlind

Introduction

Rheumatoid arthritis (RA), is a chronic inflammatory disease in which the body’s own immune system attacks the tissue in the joints. RA is a lifelong disease that leads to disability, pain and decreased quality of life. In a systematic review from 2016, Peter Taylor reports that, in this time of a broad availability of effective anti-rheumatic treatments, there are other symptoms than actual inflammatory disease activity that seem to cause a substantial burden of illness for many RA-patients. These “unmet needs” include persistent pain, fatigue, sleep problems and impaired psychosocial functioning, leading to a lower quality of life. Lee et al, have also in a paper identified a group among prevalent RA patients, who do worse in terms of these unmet needs.

In a recent report, Grabovach et al, reported that among patients with RA, not only high levels on non-optimal sleep is frequent, but that higher lack of sleep was also linked to higher pain levels. Previous research shows that pain impairs sleep, that sleep loss increases sensitivity to pain and also that sleep loss increases inflammation. To some extent this may become a downward spiral that causes unnecessary disease burden for the patients that might be stopped or eased by sleep therapy intervention.

Project details

Inst f medicin Solna (MedS)
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1
Not decided
All data have already been collected and only need to be analyzed
Ethical permit is required and exists
Supervisor/Contact

Helga Westerlind

0702222646

Helga.Westerlind@ki.se


Contact 2

Aims

The aim of this project, is to characterize the sleep quality in an early RA cohort.

Design

We will calculate sleep scores on sleep problems, non-restorative sleep, insomnia, health problems related to sleep, average time slept during a night and the patient’s own perception of sleep and sleep quality. We will look at it the distributions both one and three years into the disease.

The student selected to work with this project is required to be willing to learn programming in the statistical language R to perform the analysis.



Material and methods

This project will be based on the Swedish case-control study Epidemiological Investigation of RA (EIRA). The EIRA study was established in 1996 by professors Lars Alfredsson and Lars Klareskog, and is to date one of the largest RA case/control studies in the world where detailed information on environment/life style factors are available together with genetic factors. At diagnosis, all patients are given a questionnaire on background information and lifestyle and asked to donate blood. From 2009 and onwards, a follow up questionnaire, containing questions on lifestyle changes and patient reported outcomes were sent out to all patients one year after diagnosis (EIRA U1). Two years later, in 2011 and onwards, a corresponding questionnaire started sending out to all patients three years into the disease (EIRA U3). To date, there are over 1000 patients followed in both EIRA U1 and U3, making it a unique material.

We will collect data on sleep from EIRA U1 and U3, and sleep scores on insomnia, sleep problems, non-restorative sleep, health related sleep issues, average time slept, perception of sleep quality and sleep amount will be constructed in accordance with the well-established Karolinska Sleep questionnaire (KSQ) in close collaboration with professor Torbjörn Åkerstedt.

Project time schedule

Phase 1: planning and preparation. The student is expected to read up on the litterature, get acquainted with the data, and the statistical methods used. suggested time: 4 weeks.



Phase 2: Practical analysis and half time report. During this period it's suggested to prepare the data set and do some initial demographic analysis, as well as write the half time report. suggested time: 6 weeks.



Phase 3: continued data analysis and final report. Perform the main statistical analysis, interpret the data and write the report. Suggested to spend 6 weeks on the analysis, do a bit or writing on the report at the side, and spend the last 4 weeks focusing on the report.

Collected data/reagents

Outcome measures are sleep scores on sleep problems, non-restorative sleep, insomnia, health problems related to sleep, average time slept during a night and the patient’s own perception of sleep and sleep quality.

Backup plan

The data is available and will be ready to work with at the time of the project start. The statistical methodology is in place. There is support for statistical methods, technical questions, epidemiological methods, and clinical questions available.

Teaching/Supervision activities

Weekly supervision meeting to ensure progress with the project. Weekly research group meetings. Suggested also to join a monthly meeting with programming activities.

Resources

A computer for the analysis will be provided by the supervisor.

Miscellaneous

The student selected to work with this project is expected to be willing to learn programming in the statistical language R to perform the analysis.

Supervisor Helga Westerlind

Supervisor(s), description
I'm a computational epidemiologist working as an assistant professor at the clinical epidemiology division (KEP). My main work is in rheumatoid arthritis (RA) and identification of factors important for risk and progression of the diseases.