title: Sleep disruption frequency in rheumatoid arthritis: perceived stress predicts poor outcome over one year.
abstract: BACKGROUND
  Sleep is an important daily process that can be disrupted by chronic illnesses including rheumatoid arthritis (RA).
  
  
  OBJECTIVE
  We tested whether demographic, medical and psychological factors act as predictors of change in frequency of sleep disruption associated with RA.
  
  
  METHODS
  A cohort of 129 White British people with RA (mean duration of RA 7.19 years; mean age 55.40 years; 75% women) was followed for one year. Self-report questionnaires were employed to record demographic information and assess participants' sleep disruption (on a 4-point frequency scale), morning stiffness (duration), pain and fatigue (visual analogue scales), impact of disability, anxiety, depression, stress, coping, illness perceptions and self-efficacy. Hospital notes were reviewed for duration of RA, antidepressant use and comorbidity.
  
  
  RESULTS
  Participants were split into those with sleep disruption that was consistently infrequent or decreasing in frequency (n = 56; 43%) and those with sleep disruption that was consistently frequent or increasing in frequency (n = 73; 57%). Results of a logistic regression demonstrated that greater perceived stress at baseline predicted sleep disruption that was consistently frequent or increasing in frequency over the year. Change in sleep disruption frequency was not predicted by any other assessed variable. Perceived stress at the end of the year was not predicted by change in frequency of sleep disruption.
  
  
  CONCLUSIONS
  Self-reported frequency of sleep disruption among people with RA relates to perceived stress. Psychoeducational programmes that help people with RA manage their stress may be a non-pharmacological method of improving sleep quality and therefore merits testing in specific interventional studies.
authors.affiliation: School of Psychology, University of Birmingham, UK. g.j.treharne@bham.ac.uk
authors.forename: G J
authors.initials: GJ
authors.lastname: Treharne
authors.forename: A C
authors.initials: AC
authors.lastname: Lyons
authors.forename: E D
authors.initials: ED
authors.lastname: Hale
authors.forename: K M J
authors.initials: KM
authors.lastname: Douglas
authors.forename: C E
authors.initials: CE
authors.lastname: Goodchild
authors.forename: D A
authors.initials: DA
authors.lastname: Booth
authors.forename: G D
authors.initials: GD
authors.lastname: Kitas
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012649:Self Concept; D012893:Sleep Wake Disorders / Q000209:etiology*; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D013997:Time Factors