The SQUADRON Study
Research type
Research Study
Full title
Sleep Quality and Depression in Rheumatoid, Observational Study
IRAS ID
244240
Contact name
Sandeep Dahiya
Contact email
Sponsor organisation
North West Anglia NHS Foundation Trust Reasearch and Development
Duration of Study in the UK
0 years, 2 months, 1 days
Research summary
This is an observational study to determine if rheumatoid arthritis with high disease activity scores (DAS), have worse sleep and lower mood. Particularly if any individual components of DAS (tender joint count, swollen joint count, visual analogue score and ESR blood result), have significantly stronger correlation with poor sleep quality and depression than others.
Determining the predominant cause of high disease activity score is often a challenge for rheumatologists. Patients above a certain threshold can be commenced on biological therapy, which provide very effective immunosuppression but are costly and risk side effects. Initiating these therapies may not be appropriate if the patient is suffering from pain sensitization/fibromyalgia overlap, which will not improve with immunosuppression. These patients may benefit from improving sleep, regular exercise and treating any mental health illness, such as depression.
This study seeks to determine if patients likely to be suffering poor sleep quality and low mood can be identified by examining the components of rheumatoid DAS (disease activity score) for evidence of pain sensitisation. This can be determined by dividing the sum of tender joint count and VAS (visual analogue score) components by the total DAS.
Patients with rheumatoid arthritis attending their outpatient rheumatology appointments will be offered to complete two questionnaires, the Pittsburgh Sleep Quality Index, which quantifies sleep quality and the Patient Health Questionnaire 9, which both screens for depression and quantifies severity.
If a clear correlation can be proven between pain sensitisation and poor sleep/mood, greater than the correlation between overall DAS and poor sleep/mood then this may prevent some patients inappropriately being commenced on biological therapy for predominantly non-inflammatory pain.
High DAS has previously been shown to be strongly associated with poor sleep and depression (Westhovens et al. 2014) but to the best of our knowledge, strength of correlation for individual DAS components has not been assessed.
REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
18/WM/0137
Date of REC Opinion
17 May 2018
REC opinion
Favourable Opinion