In Behçet Disease, Sleep Plays Crucial Role in Patient-Reported Outcomes

A new study has identified sleep as the most important factor associated with low self-rated wellness and health status among patients with Behçet disease (BD).

“Recently, the quality of life and lifestyle factors in patients suffering from chronic diseases has become a topic of debate concerning their inevitable consequences and influences on several aspects of patients’ physical and mental health through a lifelong disease course,” the researchers wrote.

To assess the association between various lifestyle factors and patient-reported outcomes in BD, the researchers collected data on demographics, body mass index (BMI), smoking habits, mood status, sleep quality, physical activity levels, nutritional data, symptoms, signs, laboratory findings, and self-rated wellness and health from 52 patients with BD.

Among all patients, 100% had oral aphthous, 52% had genital aphthous, 92% had past or present ocular involvement, 36.5% had pathergy, 9.5% had skin involvement, 4% had vascular involvement, and 0% had central nervous system involvement.

On a scale from 0 to 20, with 20 being the healthiest, the mean self-rated wellness and health score was 14.6. 

In regard to lifestyle factors, the mean values were 17.7 out of 70 on the Mini-Sleep Questionnaire, 13.8 out of 35 on the Gallup Well-Being Index, and 9 out of 21 on the Gallup Diet Questionnaire.

Associations between self-rated wellness and health status and lifestyle factors were adjusted for age, gender, BMI, major symptoms and signs, and laboratory findings. 

A significant association between sleep quality, mood status, and disease duration with patients’ status in terms of self-rated wellness and health was seen through univariable regression analysis. However, multivariable linear regression showed that only sleep quality was a significant predictive variable associated with self-rated wellness and health.

In fact, the researchers determined that even with just one-third of sleep quality being disrupted, patients with BD may report significantly lower wellness and health status.

“It seems some aspects of sleep quality are more important than the other ones. Difficulty falling asleep, waking up too early, snoring, excessive daytime sleepiness, and feeling tired upon waking up in the morning were the top sleep disruptions in our patients,” the researchers wrote. “The possible mechanism of sleep and inflammatory disorders may come from an imbalance in crucial stages of sleep. Too little deep sleep and too much REM sleep cause hormonal imbalance affecting the level of inflammation.”

—Colleen Murphy

Reference:

Masoumi M, Tabaraii R, Shakiba S, Shakeri M, Smiley A. Association of lifestyle elements with self-rated wellness and health status in patients with Behcet’s disease. BMC Rheumatol. Published online September 27, 2020. doi:10.1186/s41927-020-00148-1