 |
|
|
 |
CASSIA M. PASSARELLI, SUELY ROIZENBLATT, CLAUDIO A. LEN, GUSTAVO A. MOREIRA, MARIA CECILIA LOPES, CHRISTIAN GUILLEMINAULT, SERGIO TUFIK, and MARIA ODETE E. HILARIO ABSTRACT. Methods. Twenty-one patients with active polyarticular JRA and 20 healthy controls were enrolled consecutively. Pain and functional impairment were assessed with standardized, validated Brazilian questionnaires. Sleep evaluation was based on parent reporting of their child's sleep habits and polysomnography; subjects underwent an adaptation night in the sleep laboratory. Sleep architecture was analyzed and spectral analysis of non-rapid eye movement (REM) sleep was carried out by electroencephalography. Results. Patients with JRA exhibited higher indexes of periodic leg movements (PLM; p = 0.02), isolated leg movements (LM), and arousals, as well as increases in alpha activity in non-REM sleep (all p < 0.01), in spite of similar frequency of sleep complaints in comparison to controls. Among JRA patients, greater alpha activity in non-REM sleep was observed in the participants with greater joint involvement assessed by the Escola Paulista de Medicina-Pediatric Range of Motion Scale (p = 0.03) or joint count (p = 0.02). Correlation was observed between morning stiffness and PLM and/or LM (rS = 0.75, Sr = 0.74, p < 0.001 for both), and between self-rating scores of pain and alpha activity in non-REM sleep (rS = 0.74, p < 0.001). Conclusion. Pain symptoms and disability are related to sleep fragmentation in patients with active polyarticular JRA. (First Release Mar 1, 2006; J Rheumatol 2006;33:796–802)
Key Indexing Terms: JUVENILE RHEUMATOID ARTHRITIS
From the Department of Pediatrics and Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; and the Sleep Disorders Center, Stanford University, Palo Alto, California, USA. Supported by AFIP and FAPESP/CEPID (98/14303-3). C.M. Passarelli, MD, Researcher, Department of Pediatrics; S. Roizenblatt, MD, PhD, Associate Professor, Department of Psychobiology; C.A. Len, MD, PhD, Associate Professor, Department of Pediatrics; G.A. Moreira, MD, PhD, Researcher, Department of Psychobiology, UNIFESP; M.C. Lopes, MD, Researcher; C. Guilleminault, MD, PhD, Director, Sleep Disorders Center, Stanford University; S. Tufik, MD, PhD, Chair, Department of Sleep Medicine; M.O.E. Hilario, MD, PhD, Director of Pediatric Rheumatology, Department of Pediatrics, UNIFESP. Address reprint requests to Dr. S. Roizenblatt, Departamento de Psicobiologia, Universidade Federal de São Paulo, Av. Angélica 1045 andar 5, CEP 01227–100, São Paulo, SP, Brazil. E-mail: suelyroi@psicobio.epm.br Accepted for publication November 23, 2005.
|
