title: Using actigraphy to measure sleep patterns in rheumatoid arthritis: a pilot study in patients taking night-time prednisone.
abstract: OBJECTIVE
  Poor sleep quality is a commonly reported but under-investigated consequence of rheumatoid arthritis (RA). Actigraphy is a non-invasive way of measuring sleep, estimated from the frequency and intensity of physical movement at the wrist. We used actigraphy to measure sleep parameters compared with sleep questionnaire data, and assessed the practicality of actigraph use in patients with RA.
  
  
  METHODS
  In a pilot study of actigraphy conducted within an investigation of night-time prednisone treatment and circadian interleukin-6 concentrations in ten patients with active RA, we compared actigraphy with the St Mary's Hospital Sleep Questionnaire and assessed whether night-time administration of prednisone resulted in increased sleep disturbance.
  
  
  RESULTS
  The actigraph watch was well tolerated by our patients, producing adequate data for analysis for 128 out of 133 test days (96.2%). The results indicated reasonable concordance between actigraph and sleep questionnaire data in the present sample. Patient satisfaction with sleep (question 11) strongly correlated with sleep efficiency measured by the actigraph (r = 0.71, p = 0.22) and showed a trend for inverse correlation with the fragmentation index (r = -0.60, p = 0.067). Quality of sleep (question 9) correlated non-significantly with the fragmentation index (r = -0.59, p = 0.072). We were unable to identify any significant correlations between clinical measures of disease and sleep parameters in this sample. There were no apparent detrimental consequences of the night-time dose of prednisone on the measures of sleep quality and quantity.
  
  
  CONCLUSIONS
  In spite of the physical disability imposed by RA, the actigraph was well tolerated and gave a useful measure of sleep in patients with active disease. It has the potential for use in larger controlled trials.
authors.affiliation: University of Bristol Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK.
authors.forename: Lynsey L
authors.initials: LL
authors.lastname: Clarke
authors.forename: Sue
authors.initials: S
authors.lastname: Wilson
authors.forename: John R
authors.initials: JR
authors.lastname: Kirwan
mesh_terms: D056044:Actigraphy / Q000295:instrumentation* / Q000379:methods*; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D002940:Circadian Rhythm; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D011241:Prednisone / Q000627:therapeutic use*; D012890:Sleep / Q000187:drug effects; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000209:etiology; D011795:Surveys and Questionnaires; D014953:Wrist
chemical_list: D005938:Glucocorticoids; D011241:Prednisone
keywords: Rheumatoid arthritis; actigraphy; glucocorticoids; sleep