ABSTRACT
Background: Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) may have a profound impact on health-related quality of life (HRQoL) and sleep despite effective treatment. Objectives: To assess sleep and HRQoL in SpA and determine associated factors. Methods: Monocentric questionnaire-based assessment of HRQoL, function, sleep and depression in 314 SpA patients (n=168 PsA, n=146 axSpA). Results: Under effective treatment 138 SpA patients (46.5%) demonstrated abnormal sleep behaviour. 49.3% reported not being able to sleep through the night, with 6.1 % needing sleeping pills. 11.9% indicated feeling unrefreshed most mornings. Abnormal sleep behaviour was associated with female sex (p=0.005), HLAB27 (p=0.034), functional impairment (p=0.001) and depression (p<0.001). Patients reporting unrestful sleep had signifcantly more depressive symptoms (p<0.001) and highly reduced physical and mental HRQoL (p<0.001). Satisfaction with health was rated signifcantly lower (p<0.001). Patients with axial involvement (axSpA/axPsA) reported worse sleep quality (p=0.002) and waking too early (p=0.038) despite 73.7% receiving biologics. Sleep quality and early awakening correlated with BASDAI (p<0.001). Smokers had a reduced HRQoL (p=0.018) despite younger age (p=0.008). Female patients had worse sleep quality (p<0.001), needing more time to fall asleep (p=0.022), not being able to sleep through the night (p=0.026) and feeling unrefreshed in the morning (p<0.001). They had a reduced physical (p=0.019) and mental HRQoL (p=0.003), more depressive symptoms (p=0.040) and lower functional capacity (p=0.002). Functional capacity was associated with younger age (p<0.001), sex (p=0.042), smoking (p=0.008), sleep quality (p<0.001) and depression (p<0.001). 66.2% of patients have been assessed longitudinally, before and 3y later during COVID19 pandemic. Physical and mental HRQoL were stable over time. Functional capacity had decreased slightly. Subjective QoL during the COVID19 pandemic was not reduced compared to before. Regarding depressive symptoms, there was a mild but signifcant improvement over time (p=0.019). Furthermore, we observed an improvement of environmental QoL (p=0.034) during COVID pandemic. Overall subjective QoL as well as satisfaction with health did not change signif-cantly. Patients who had changed therapy (37% of the cohort) still had a reduced physical HRQoL (p=0.022) as well as signifcantly more depressive symptoms (p=0.010) and perceived their overall QoL as being worse (p=0.016). Conclusion: Despite treatment many SpA patients have a reduced HRQoL and impaired sleep quality with signifcant differences between male and female patients. Impact of COVID19 pandemic was low.