Advertisement

Sleep impairments and quality of life in Thai adolescents with systemic lupus erythematosus

Published:September 30, 2022DOI:https://doi.org/10.1016/j.pedn.2022.09.017

      Abstract

      Purpose

      Adolescents with systemic lupus erythematosus (SLE) are susceptible to sleep impairments. We aimed to determine the prevalence and factors related to sleep impairments, and the associations of sleep impairments with health-related quality of life (HRQOL) in Thai adolescents with SLE.

      Methods

      Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire for Adolescents (PHQA), and Pediatric Quality of Life Inventory™ 4.0 Core Scales were administered to 57 participants with SLE aged 13–18 years to evaluate sleep, depression, and HRQOL, respectively. Participants were divided into “good sleep” (PSQI scores <5) and “poor sleep” groups (PSQI scores ≥5). Participants with body mass index (BMI) >23 kg/m2 were classified into the high BMI group.

      Findings

      Eighteen participants (31.6%) were in the poor sleep group. High BMI and PHQA scores were associated with sleep impairments with the odds ratio of 8.00 (95% CI 1.50–42.64; p = 0.02), and 1.25 (95% CI 1.01–1.54; p = 0.04), respectively. In terms of HRQOL, adolescents with SLE had the highest scores in social functioning and the lowest scores in school functioning. Good sleepers had better scores than poor sleepers across all sub-categories except for social functioning, and the difference was significant in emotional functioning (90% (IQR 75–100) vs. 70% (IQR 55–85); p = 0.03).

      Conclusions

      A substantial number of adolescents with SLE had sleep impairments, which decreased HRQOL, particularly in emotional functioning. Sleep impairments were associated with obesity and depression.

      Implications

      Proactive management in addressing weight, mood, and sleep problems should be included in the multidisciplinary care of adolescents with SLE to improve their health and well-being.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Aringer M.
        • Costenbader K.
        • Daikh D.
        • Brinks R.
        • Mosca M.
        • Ramsey-Goldman
        • Johnson S.R.
        2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus.
        Annals of the Rheumatic Diseases. 2019; 78: 1151-1159
        • Beattie L.
        • Kyle S.D.
        • Espie C.A.
        • Biello S.M.
        Social interactions, emotion and sleep: A systematic review and research agenda.
        Sleep Medicine Reviews. 2015; 24: 83-100
        • Buysse D.J.
        • Reynolds C.F.
        • Monk T.H.
        • Berman S.R.
        • Kupfer D.J.
        The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice.
        Psychiatry Research. 1989; 28: 193-213
        • Cole J.C.
        • Motivala S.J.
        • Buysse D.J.
        • Oxman M.N.
        • Levin M.J.
        • Irwin M.R.
        Validation of a 3-factor scoring model for the Pittsburgh sleep quality index in older adults.
        Sleep. 2006; 29: 112-116
        • El-Gamasy M.A.
        Sleep architecture in pediatric patients with lupus nephropathy.
        Pediatrics and Health Research. 2017; 2: 7
        • Erickson J.M.
        Approaches to measure sleep-wake disturbances in adolescents with cancer.
        Journal of Pediatric Nursing. 2009; 24: 255-269
        • Erwin A.M.
        • Bashore L.
        Subjective sleep measures in children: Self-report.
        Frontiers in Pediatrics. 2017; 5: 22
        • Figueiredo-Braga M.
        • Cornaby C.
        • Cortez A.
        • Bernardes M.
        • Terroso G.
        • Figueiredo M.
        • Poole B.D.
        Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors.
        Medicine (Baltimore). 2018; 97e11376
        • Gladman D.D.
        • Ibanez D.
        • Urowitz M.B.
        Systemic lupus erythematosus disease activity index 2000.
        The Journal of Rheumatology. 2002; 29: 288-291
        • Gohil A.
        • Hannon T.S.
        Poor sleep and obesity: Concurrent epidemics in adolescent youth.
        Frontier Endocrinology (Lausanne). 2018; 9: 364
        • Hakim F.
        • Kheirandish-Gozal L.
        • Gozal D.
        Obesity and altered sleep: A pathway to metabolic derangements in children?.
        Seminars in Pediatric Neurology. 2015; 22: 77-85
        • Hazell P.
        Depression in children and adolescents: Complementary therapies.
        BMJ Clinical Evidence. 2015; 2015
        • Jitnarin N.
        • Kosulwat V.
        • Rojroongwasinkul N.
        • Boonpraderm A.
        • Haddock C.K.
        • Poston W.S.
        Prevalence of overweight and obesity in Thai population: Results of the National Thai Food Consumption Survey.
        Eating and Weight Disorders. 2011; 16: e242-e249
        • Johnson J.G.
        • Harris E.S.
        • Spitzer R.L.
        • Williams J.B.
        The patient health questionnaire for adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients.
        The Journal of Adolescent Health. 2002; 30: 196-204
        • Jongvilaikasem P.
        • Rianthavorn P.
        Longitudinal growth patterns and final height in childhood-onset systemic lupus erythematosus.
        European Journal of Pediatrics. 2021; 180: 1431-1441
        • Lillis T.A.
        • Tirone V.
        • Gandhi N.
        • Weinberg S.
        • Nika A.
        • Sequeira W.
        • Jolly M.
        Sleep disturbance and depression symptoms mediate relationship between pain and cognitive dysfunction in lupus.
        Arthritis Care & Research (Hoboken). 2019; 71: 406-412
        • Margiotta D.P.E.
        • Basta F.
        • Dolcini G.
        • Batani V.
        • Lo Vullo M.
        • Vernuccio A.
        • Afeltra A.
        Physical activity and sedentary behavior in patients with systemic lupus erythematosus.
        PLoS One. 2018; 13e0193728
        • Maslow G.R.
        • Haydon A.
        • McRee A.L.
        • Ford C.A.
        • Halpern C.T.
        Growing up with a chronic illness: Social success, educational/vocational distress.
        The Journal of Adolescent Health. 2011; 49: 206-212
        • Mina R.
        • Klein-Gitelman M.S.
        • Nelson S.
        • Eberhard B.A.
        • Higgins G.
        • Singer N.G.
        • Brunner H.I.
        Effects of obesity on health-related quality of life in juvenile-onset systemic lupus erythematosus.
        Lupus. 2015; 24: 191-197
        • Mirbagher L.
        • Gholamrezaei A.
        • Hosseini N.
        • Sayed Bonakdar Z.
        Sleep quality in women with systemic lupus erythematosus: Contributing factors and effects on health-related quality of life.
        International Journal of Rheumatic Diseases. 2016; 19: 305-311
        • Mouthon A.L.
        • Huber R.
        Methods in pediatric sleep research and sleep medicine.
        Neuropediatrics. 2015; 46: 159-170
        • Nam S.
        • Stewart K.J.
        • Dobrosielski D.A.
        Lifestyle intervention for sleep disturbances among overweight or obese individuals.
        Behavioral Sleep Medicine. 2016; 14: 343-350
        • Ophoff D.
        • Slaats M.A.
        • Boudewyns A.
        • Glazemakers I.
        • Van Hoorenbeeck K.
        • Verhulst S.L.
        Sleep disorders during childhood: A practical review.
        European Journal of Pediatrics. 2018; 177: 641-648
        • Ozer S.
        • Kankaya H.
        • Gun R.
        • Yeler N.
        • Marangoz O.
        • Bozca H.
        Factors affecting sleep quality in patients with systemic lupus erythematosus.
        Lupus. 2022; 31: 39-44
        • Palagini L.
        • Tani C.
        • Mauri M.
        • Carli L.
        • Vagnani S.
        • Bombardieri S.
        • Gemignani A.
        • Mosca M.
        Sleep disorders and systemic lupus erythematosus.
        Lupus. 2014; 23: 115-123
        • Panyawong W.
        • Pavasuthipaisit C.
        • Santitadakul R.
        Validation of the Thai Version of the Patient Health Questionnaire for Adolescents (PHQ-A) in adolescent psychiatric patients.
        International Journal of Child Development and Mental Health. 2020; 8
        • Parekh P.J.
        • Oldfield Iv E.C.
        • Challapallisri V.
        • Ware J.C.
        • Johnson D.A.
        Sleep disorders and inflammatory disease activity: Chicken or the egg?.
        The American Journal of Gastroenterology. 2015; 110: 484-488
        • Paruthi S.
        • Brooks L.J.
        • D’Ambrosio C.
        • Hall W.A.
        • Kotagal S.
        • Lloyd R.M.
        • Wise M.S.
        Consensus statement of the American academy of sleep medicine on the recommended amount of sleep for healthy children: Methodology and discussion.
        Journal of Clinical Sleep Medicine. 2016; 12: 1549-1561
        • Perez de Heredia F.
        • Garaulet M.
        • Gomez-Martinez S.
        • Diaz L.E.
        • Warnberg J.
        • Androutsos O.
        • Helena Study Group
        Self-reported sleep duration, white blood cell counts and cytokine profiles in European adolescents: The HELENA study.
        Sleep Medicine. 2014; 15: 1251-1258
        • Phillips S.R.
        • Johnson A.H.
        • Shirey M.R.
        • Rice M.
        Sleep quality in school-aged children: A concept analysis.
        Journal of Pediatric Nursing. 2020; 52: 54-63
        • Quilter M.C.
        • Hiraki L.T.
        • Korczak D.J.
        Depressive and anxiety symptom prevalence in childhood-onset systemic lupus erythematosus: A systematic review.
        Lupus. 2019; 28: 878-887
        • Sanchez-Lopez A.M.
        • Noack-Segovia J.P.
        • Nunez-Negrillo A.M.
        • Latorre-Garcia J.
        • Aguilar-Cordero M.J.
        Childhood obesity and its influence on sleep disorders: Kids-play study.
        International Journal of Environmental Research and Public Health. 2020; 17
        • Schwartz G.J.
        • Munoz A.
        • Schneider M.F.
        • Mak R.H.
        • Kaskel F.
        • Warady B.A.
        • Furth S.L.
        New equations to estimate GFR in children with CKD.
        Journal of the American Society of Nephrology. 2009; 20: 629-637
        • Sinicato N.A.
        • Postal M.
        • Peres F.A.
        • Pelicari Kde O.
        • Marini R.
        • dos Santos Ade O.
        • Appenzeller S.
        Obesity and cytokines in childhood-onset systemic lupus erythematosus.
        Journal of Immunology Research. 2014; 2014162047
        • Sitasuwan T.
        • Bussaratid S.
        • Ruttanaumpawan P.
        • Chotinaiwattarakul W.
        Reliability and validity of the Thai version of the Pittsburgh Sleep Quality Index.
        Journal of the Medical Association of Thailand. 2014; 97: S57-S67
        • Sritipsukho P.
        • Wisai M.
        • Thavorncharoensap M.
        Reliability and validity of the Thai version of the pediatric quality of life inventory 4.0.
        Quality of Life Research. 2013; 22: 551-557
        • Thorburn-Winsor E.A.
        • Neufeld S.A.S.
        • Rowthorn H.
        • van Sluijs E.M.F.
        • Brage S.
        • Jones P.B.
        • Winpenny E.M.
        Device-measured sleep onset and duration in the development of depressive symptoms in adolescence.
        Journal of Affective Disorders. 2022; 310: 396-403
        • Ugarte-Gil M.F.
        • Gamboa-Cardenas R.V.
        • Reategui-Sokolova C.
        • Pimentel-Quiroz V.R.
        • Medina M.
        • Elera-Fitzcarrald C.
        • Perich-Campos R.A.
        Severe flares are associated with a poorer health-related quality of life (HRQoL) in patients with SLE: Data from the Almenara lupus cohort.
        Lupus Sci Med. 2022; 9
        • Varni J.W.
        • Seid M.
        • Kurtin P.S.
        PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations.
        Medical Care. 2001; 39: 800-812
        • Weening J.J.
        • D’Agati V.D.
        • Schwartz M.M.
        • Seshan S.V.
        • Alpers C.E.
        • Appel G.B.
        • Renal Pathology Society Working Group on the Classification of Lupus Nephritis
        The classification of glomerulonephritis in systemic lupus erythematosus revisited.
        Kidney International. 2004; 65: 521-530
        • WHO Expert Consultation
        Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
        Lancet. 2004; 363: 157-163
        • Wu L.
        • Shi P.L.
        • Tao S.S.
        • Tao J.H.
        • Wu G.C.
        Decreased sleep quality in patients with systemic lupus erythematosus: A meta-analysis.
        Clinical Rheumatology. 2021; 40: 913-922
        • Yin R.
        • Li L.
        • Xu L.
        • Sui W.
        • Niu M.
        • Xu R.
        • Srirat C.
        Association between depression and sleep quality in patients with systemic lupus erythematosus: A systematic review and meta-analysis.
        Sleep & Breathing. 2022; 26: 429-441
        • Zhai L.
        • Zhang H.
        • Zhang D.
        Sleep duration and depression among adults: A meta-analysis of prospective studies.
        Depression and Anxiety. 2015; 32: 664-670
        • Zhao Q.
        • Deng N.
        • Chen S.
        • Cui Y.
        • Du X.
        • Gu Z.
        Systemic lupus erythematosus is associated with negatively variable impacts on domains of sleep disturbances: A systematic review and meta-analysis.
        Psychology, Health & Medicine. 2018; 23: 685-697