TOPLINE:

A vast majority of patients with rheumatoid arthritis (RA) experienced at least one objectively-measured sleep disorder, and some of those disorders were significantly associated with greater clinical disease activity.

METHODOLOGY:

• Researchers evaluated the prevalence of objectively-measured sleep characteristics in adults with RA and their associations with disease activity using data collected at baseline and 6-, 12-, and 18-month periods.
• Patients wore an actigraph for seven consecutive nights during all periods and another wrist-worn device (WatchPAT) for two consecutive nights during the baseline period.
• The analysis included 116 patients (mean age, 57.9 years; 88.8% women) with sufficient actigraph data at baseline. A subset of 63 patients completed WatchPAT monitoring.
• Actigraphy measured sleep efficiency (poor if < 85%), time awake after sleep onset, and total sleep time. WatchPAT assessed sleep-disordered breathing using apnea-hypopnea index.
• Rheumatologists used Disease Activity Scores (DAS) in 28 joints, with both erythrocyte sedimentation rate and C-reactive protein (CRP), and clinical disease activity index (CDAI) scores to assess disease activity before each sleep monitoring period.

TAKEAWAY:

• At all measurement periods, 41.4% of patients had poor sleep efficiency, 56.9% had more than 60 minutes of time awake after sleep onset, and 40.5% had < 7 hours of sleep per night.
• More than half of the patients who completed WatchPAT monitoring had moderate-to-severe obstructive sleep apnea, and only 54.3% of those reported a prior diagnosis of the condition.
• Poor sleep efficiency and greater time awake after sleep onset were each significantly associated with greater disease activity across all measures (P <.05 for all); total sleep time showed no such association.
• Apnea-hypopnea index ≥ 15 was associated with increased disease activity as measured by CDAI and DAS‑CRP scores (P <.05 for both).

IN PRACTICE:

“Given the high rates of sleep disorders, the significant negative general and RA-specific health effects of sleep disorders, and the existence of treatments that can improve sleep quality, our findings point to a critical need for greater attention to sleep disorders among individuals living with RA,” the authors wrote.

SOURCE:

This study was led by Patricia Katz, PhD, University of California San Francisco. It was published online on October 24, 2025, in Arthritis Care & Research.

LIMITATIONS:

WatchPAT measurements and in-person disease activity assessments were halted due to the COVID pandemic, thus reducing the sample size. Limited follow-ups prevented the analysis of longitudinal associations. The cohort had relatively l ow disease activity and pain, which limited generalizability to more severe RA.

DISCLOSURES:

This study was funded by a grant from the National Institute of Arthritis, Musculoskeletal, and Skin Diseases.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.