title: Sleep quality in women with systemic lupus erythematosus: contributing factors and effects on health-related quality of life.
abstract: OBJECTIVE
  Sleep quality disturbances are common in patients with systemic lupus erythematosus (SLE). We evaluated sleep quality and its contributors in women with SLE. Also we evaluated the effects of sleep quality disturbance on patients' health-related quality of life (HRQoL).
  
  
  METHODS
  Sleep quality was assessed in 77 women with SLE (age 36.5 ± 10.1 years) using the Pittsburgh Sleep Quality Index (PSQI). Disease activity and cumulative disease damage were assessed with standard indices. Patients completed the Hospital Anxiety and Depression Scale and LupusQoL. Univariate and multivariate analyses were performed to find contributors of poor sleep quality and association of sleep quality with HRQoL.
  
  
  RESULTS
  Poor sleep quality was present in 44 patients (57.1%). Poor sleepers were older (P = 0.015) and had higher body mass index (P = 0.027) and more severe anxiety (P < 0.001) and depression symptoms (P < 0.007) compared with good sleepers. In the logistic regression model, age (β = 1.16, P = 0.006), disease activity (β = 1.10, P = 0.050), and anxiety/depression composite score (β = 1.16, P = 0.008) were independent contributors of poor sleep quality. Poor sleepers had impaired HRQoL in almost all domains of the LupusQoL than good sleepers (P < 0.05).
  
  
  CONCLUSIONS
  Poor sleep quality is common in women with SLE and significantly impairs their HRQoL. Age, disease activity and psychological factors were determinants of sleep quality in our study. Studies with objective sleep measures as well as interventional studies are warranted in this regard.
authors.affiliation: Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Mirbagher
authors.affiliation: Poursina Hakim Research Institute, Isfahan, Iran.
authors.forename: Ali
authors.identifier: http://orcid.org/0000-0001-8674-450X
authors.initials: A
authors.lastname: Gholamrezaei
authors.affiliation: Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Naeimeh
authors.initials: N
authors.lastname: Hosseini
authors.affiliation: Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Sayed Bonakdar
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D012890:Sleep; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: anxiety; depression; quality of life; sleep; systemic lupus erythematosus