Patterns of Sleep and Activity Among Adults With Arthritis

A new study has identified 4 subgroups of patients with arthritis based on their 24-hour activity-sleep profiles, which may allow for tailored interventions to support patients with arthritis to modify their activity or sleep behaviors. The findings were published in Arthritis Care & Research.

Pain, fatigue, limited joint and muscle function, and mood disruption associated with arthritis may cause patients with the disease to be less active and have poorer sleep quality and quantity, the authors noted.

"We all live our daily lives over 24 hours, and our study found that people with arthritis are likely to have 1 of 4 distinctly different patterns for how they allocate time in sleep and a variety of activities throughout their day," lead author Lynne Feehan, PT, PhD, Department of Physical Therapy, University of British Columbia, said in a statement. "This suggests that a one-size-fits-all approach to supporting people with arthritis to modify their daily sleep or physical activity choices may not be appropriate."

The cross-sectional study used baseline data from 2 randomized clinical trials studying the effect of physical activity counseling. The SuPRA study included patients with knee osteoarthritis (OA), and the OPAM-IA study included patients with rheumatoid arthritis or systemic lupus erythematosus (SLE).

The researchers measured 24-hour activity via activity monitors that patients wore for 1 week on the upper arm of the nondominant arm. The monitors were removed for water-based activities. The participants included in the study had activity data for 4 to 6 days from midnight to midnight, with at least 20 hours of wear.

The study cohort consisted of 172 participants, of which 88 (51%) had RA, 52 (30%) had knee OA, and 32 (19%) had SLE. The participants reported their usual occupation as being employed (n = 74; 43%), retired (n = 45; 26%), household work (n = 31; 18%), or as student, volunteer, or other (n = 22, 13%). The average (SD) daily step count was 5990 (3234), and days of wear was 5.9 (0.4). The average depression score was 7.0 (5.6) out of 27 as measured by the Patient Health Questionnaire-9.

Based on the data gathered, the researchers identified 4 profiles:

• Balanced Activity: the 40 participants in this cluster, on average, spent 7.4 hours sleeping, 1.5 hours resting (lying down with no sleep identifiers), 9.4 hours in nonambulatory activity (non-tlying down, no step count), 4.4 hours in intermittent walking (non-lying down, < 50 steps per minute) , and 0.8 hours in purposeful walking (non-lying down, > 50 steps per minute).
• High Sleepers: the 45 participants in this cluster, on average, spent 8.4 hours sleeping, 1.9 hours resting, 10.4 hours in nonambulatory activity, 2.5 hours in intermitten walking, and 0.3 hours in purposeful walking.
• Low Sleepers: the 52 participants in this cluster, on average, spent 6.5 hours sleeping, 1.1 hours resting, 12.2 hours in nonambulatory activity, 3.3 hours in intermittent walking, and 0.6 hours in purposeful walking.
• High Sitters: the 35 participants in this cluster, on average, spent 6.9 hours sleeping, 1.6 hours resting, 13.2 hours in nonambulatory activity, 1.6 hours in intermittent walking, and 0.3 hours in purposeful walking.

Participants in the Low Sleepers and High Sitters clusters were slightly older than the other clusters (61 vs 55 years), and the Balanced Activity and Low Sleepers clusters had a slightly lower body mass index compared with the other clusters (~2 vs ~30 kg/m²).

Low Sleepers had an average (SD) daily step count of 6706 (2618), and the Balanced Activity cluster had 9379 (3086) steps, while High Sitters only had 3317 (1729) daily steps and High Sleepers, 3317 (1729) to 4229 (1423) steps. Depression score was lowest among the participants in the Balanced Activity cluster (6.3) followed closely by High Sitters (6.4) and Low Sleepers (6.6). High Sleepers had a significantly higher depression score (8.5).

According to the authors, further larger-scale prospective cohort investigations can examine variations in and the characteristics of 24-hour activity-sleep profiles.

“This study provides preliminary evidence that there are likely to be distinctly different profiles for 24-hour activity and sleep in adults with arthritis that are potentially definable in terms of individual or clinical characteristics associated with profile membership,” they concluded. “Findings also suggest that targeting or tailoring activity interventions for individuals with arthritis based on 24-hour sleep activity and sleep profiles may be indicated, particularly in adults with stronger habitual sitting or weaker habitual walking behaviors.”

Reference

Feehan LM, Lu N, Xie H, Li LC. 24-hour activity and sleep profiles for adults living with arthritis: habits matter. Arthritis Care Res (Hoboken). Published online October 6, 2020. doi:10.1002/acr.24424