Exploring sleep health and circadian rhythm disruption in Sjögren's disease: an accelerometric and self-reported cross-sectional study

Objectives In a cross-sectional study, we aimed at characterizing possible impairments in sleep health and rest–activity parameters between patients with Sjögren’s Disease (SjD) and healthy controls (HCs). Furthermore, we explored possible predictors of such disturbances in the SjD group. Methods Participants’ sleep and rest-activity rhythms were assessed via 7-day continuous accelerometry, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the reduced Morningness-Eveningness Questionnaire, allowing the creation of a multidimensional sleep health index. Parametric tests explored between-group differences in sleep and rest-activity parameters, while functional linear modelling characterized between-group, time-related differences in accelerometric activity. Within the SjD cohort, regression analysis was employed to explore disease activity, patient-reported disease burden, and the Hospital Anxiety and Depression Scale (HADS) as possible predictors of sleep and rest-activity parameters. Results Forty-six SjD patients and forty age-, sex- and BMI-matched HCs were included. Compared with HCs, SjD patients reported lower sleep health (P = 0.005) and delayed mid-sleep point (P = 0.009) and acrophase (P = 0.033). Functional linear modelling confirmed the objective shift towards eveningness in SjD patients. In SjD patients, patient-reported disease burden predicted sleep quality (β = 0.41; P = 0.044) and sleepiness (β = 0.83; P = 0.010), while disease activity predicted daily steps (β=−526; P = 0.013), total sleep time (β = 0.15; P = 0.0496) and sleep regularity (β=−1.3; P = 0.030). Finally, HADS predicted daily steps (β = −238; P = 0.041), total sleep time (β = −0.08; P = 0.035) and sleep efficiency (β = −0.65; P = 0.012). Conclusions SjD is associated with impaired sleep health and rest-activity rhythms. In SjD patients, such alterations differentially associate with disease activity and patient-reported outcomes, supporting a multifactorial model of sleep and circadian rhythms disruption.