Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögrens syndrome: a cross-sectional study

ABSTRACT BACKGROUND: Fatigue is a frequent symptom in patients with primary Sjögren's syndrome (pSS) and can be a cause of or be associated with sleep disorders. OBJECTIVE: To assess the sleep quality of pSS patients and its relationship with fatigue and disease activity. DESIGN AND SETTING: Analytical observational study conducted at an exercise psychobiology laboratory. METHODS: Sleep quality was evaluated using the Pittsburg sleep quality index (PSQI) and actigraphy. Fatigue was evaluated through the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI-SF) and a visual analogue scale for fatigue (VAS-fatigue). Disease activity was evaluated using a visual analogue scale for pain (VAS-pain), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Disease Activity Index (ESSDAI). We summarized the data through descriptive statistics. RESULTS: A total of 50 female patients with pSS, of average age 56.4 years, were included in the study; 80% presented low disease activity. The total PSQI score showed that 74% had poor sleep. The actigraphy showed mean sleep latency of 26.2 minutes and mean nightly awakening of 48.2 minutes (duration of wakings after sleep onset, WASO). There were correlations between PSQI and VAS-pain, VAS-fatigue, PROFAD-SSI and ESSPRI. Actigraphy showed a correlation between the duration of WASO and ESSDAI. CONCLUSION: The present study provides important information regarding correlations between sleep disorders and disease activity. There is a need for proper control over disease activity and for development of strategies to help patients to sleep better in order to diminish their fatigue.

Programa de autogerenciamento da dor crônica no idoso: estudo piloto / Self-management of chronic pain in the elderly: pilot study

JUSTIFICATIVA E OBJETIVOS: O programa de autogerenciamento da dor (AGD) inclui educação sobre dor, treinamento para identificação e modificação de pensamentos negativos, estabelecimento de metas, exercícios de relaxamento e terapias físicas com o objetivo de reduzir a dor, melhorar o humor e o funcionamento psicossocial. O objetivo foi avaliar o desenho metodológico e sua viabilidade em estudar a eficácia do AGD no tratamento da dor crônica em idosos e, secundariamente, avaliar sua eficácia comparando-o a um método educativo controle.MÉTODO: Foram avaliados os aspectos sociodemográficos, aspectos sobre a dor crônica e sua mensuração, impacto em funcionalidade, qualidade de vida, cognição e emoção utilizando-se: avaliação sociodemográfica, escala analógica visual (EAV) de dor, "Geriatric pain measurement" (GPM), escala de Katz e de Lawton (avaliação de funcionalidade), mini-exame do estado mental (MEEM), Geriatric Depressive Scale (GDS) e SF-36. RESULTADOS: Foram incluídos 20 indivíduos (12 no G1/intervenção e 8 no G2/controle), todos do gênero feminino, com idade média 73,7 no G1 e 78,2 no G2. A intensidade média de dor ao início do estudo foi 18,6 mm no G1, e 16,6 mm no G2, quando utilizada a EAV e pontuação média de 21,8 no G1 e 19,7 no G2, utilizando-se o GPM. Ao final do estudo a intensidade média de dor segundo a EAV foi 16,7 mm no G1 (p = 0,342) e 41,2 mm no G2 (p = 0,006). A pontuação com o GPM foi 19,7 no G1 (p = 0,400) e 25,8 no G2 (p = 0,346). As pontuações pela escala Katz foi 5,8 no início e 5,9 no final do estudo no G1 com 5,4 no início e 5,6 no final no G2 (p = 0,198). Pela escala de Lawton houve melhora funcional estaticamente significante no G1 (p = 0,040), o mesmo não ocorrendo no G2 (p = 0,148) e a diferença entre os grupos foi significante (p = 0,032). Os valores médios obtidos com os tratamentos propostos pela SF-36 não diferiram significativamente entre os grupos. CONCLUSÃO: A intervenção de AGD melhorou a independência funcional do idoso, para as atividades instrumentais de vida diária, e demonstrou tendência em melhorar a intensidade da dor e qualidade de vida.

BACKGROUND AND OBJECTIVES: The pain self-management program (PSM) includes education about pain, training to identify and change negative thinking, establishment of goals, relaxation exercises and physical therapies aiming at decreasing pain and improving mood and psychosocial functioning. This study aimed at evaluating the methodological performance and the feasibility of studying PSM effectiveness to treat chronic pain in the elderly and, secondarily, at evaluating its effectiveness as compared to a control educational method.METHOD: Social-demographic aspects, chronic pain and its evaluation, impact on functionality, quality of life, cognition and emotion were evaluated using: socio-demographic evaluation, pain visual analog scale (VAS), Geriatric pain measurement (GPM), Katz and Lawton scales (functionality evaluation), mental state mini exam (MSME), Geriatric Depressive Scale (GDS) and SF-36.RESULTS: Participated in this study 20 females (12 in the G1/intervention and 8 in G2/control groups), mean age of 73.7 in G1 and of 78.2 in G2. Mean pain intensity in the beginning of the study was 18.6 mm in G1 and 16.6 mm in G2, when VAS was used, and 21.8 in G1 and 19.7 in G2 with GPM. At the end of the study, mean pain intensity according to VAS was 16.7 mm for G1 (p = -.342) and 41.2 for G2 (p = 0.006). GPM scores were 19.7 for G1 (p = 0.400) and 25.8 for G2 (p = 0.346). Katz scale scores were 5.8 in the beginning and 5.9 at the end of the study for G1 and 5.4 in the beginning and 5.6 at the end for G2 (p = 0.198). Lawton scale showed statistically significant functional improvement for G1 (p = 0.040), the same not being true for G2 (p = 0,148) with significant difference between groups (p = 0.032). Mean values obtained with SF-36 were not statistically significant between groups.CONCLUSION: PSM intervention has improved functional independence of the elderly for daily life activities and has shown a trend to decrease intensity and improve quality of pain.