Pain, Poor Sleep Can Lead to Lower Quality of Life for Patients

Chronic pain and impairment of the autonomic nervous system — which controls internal organs and regulates body processes like heart rate, blood pressure, digestion, and respiration — affect sleep and physical functioning in people with scleroderma, which in turn can negatively affect their quality of life, a study suggests.

The study, “Cardiovascular Autonomic Control, Sleep and Health Related Quality of Life in Systemic Sclerosis,” appeared in the International Journal of Environmental Research and Public Health. 

Dysfunction of autonomic control, called dysautonomia, underlies many SSc symptoms, including chronic pain, cardiovascular impairments, and gastrointestinal disturbances.

Researchers in Italy, with a collaborator in Brazil, sought to assess the relationship between manifestations of dysautonomia, cardiovascular function, and health-related quality of life in SSc patients.

They recruited 20 patients with scleroderma between March 2019 and January 2020. Most participants were women (16 or 80%) with a median age of 56 and a disease duration of 13 years.

A total of 16 patients had limited cutaneous SSc and four had diffuse cutaneous SSc. All participants reported experiencing pain, with nine (45%) experiencing joint pain and seven (35%) experiencing muscle aches. Nine patients reported severe pain, eight moderate pain, and three mild pain.

Of the 20 patients, 15 (75%) reported significant disability in daily activities, as assessed with the Health Assessment Questionnaire. Nine (45%) reported depressive symptoms according to the Patient Health Questionnaire-9, and 18 (90%) had sleep disturbances as measured with the Pittsburgh Sleep Quality Index.

Sleep impairment was linked with sympathetic predominance at rest, a measure of autonomic system impairment. Notably, the sympathetic nervous system is part of the autonomic nervous system that induces the fight-or-flight response, making the body able to respond to perceived danger.

Higher pain levels were associated with decreased sleep quality, increased disability, and vagal modulation of heart rate — also part of autonomic control.

Poor sleep quality correlated with depressive symptoms. Also, sympathetic predominance was associated with the diffuse cutaneous subset and with anti-Scl-70 autoantibodies, which are characteristic self-targeting antibodies in people with scleroderma.

“Sleep impairment, pain and depressive symptoms are present and interrelated in patients with Systemic sclerosis, and lead to poor quality of life,” the investigators wrote. “In a chronic disease, such as SSc, sleep impairment and chronic pain should get the adequate attention from health care providers during the clinical assessment with an early recognition in order to improve patient’s quality of life.”

“Further studies are needed to enlarge the sample size and to investigate also patients in the early stages of the disease and with shorter disease duration,” they added.