Self-Reported Sleep Quality Linked to Fatigue in Rheumatoid Arthritis Patients, Study Finds

A new study published in the American College of Rheumatology highlights the strong relationship between self-reported sleep disturbances and fatigue in patients with rheumatoid arthritis (RA), reinforcing the clinical relevance of integrating subjective sleep assessments into routine care.

Conducted at a single academic rheumatology center, the cross-sectional study evaluated both subjective and objective sleep parameters in 48 adults with RA over a 14-day period. Sleep was measured objectively via actigraphy and subjectively using the Karolinska Sleep Diary. Fatigue levels were assessed using the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue computerized adaptive test.

Key findings demonstrated that self-reported sleep duration, efficiency, and quality were significantly associated with fatigue. Specifically, patients reporting longer total sleep time (ρ = –0.4, p < 0.01), higher sleep efficiency (ρ = –0.42, p < 0.01), and better sleep quality (ρ = –0.5, p < 0.01) experienced lower fatigue levels. In contrast, objective sleep measures derived from actigraphy showed no significant correlation with fatigue.

“Self-reported poor sleep duration, efficiency, and quality were significantly associated with fatigue in patients with RA,” the study states. “Objective actigraphy-based sleep parameters were not.”

The findings persisted after adjusting for key confounders, including swollen joint count, pain intensity, and symptoms of depression. This suggests that subjective sleep experiences, rather than measurable sleep behaviors alone, may play a more immediate role in the fatigue experienced by patients with RA.

These results carry important implications for clinical practice. While rheumatologists often focus on inflammatory markers or joint symptoms to explain fatigue, this study underscores the need to ask patients directly about their sleep quality.

“Supporting the integration of self-reported assessment of sleep disturbances into RA treatment plans” is a central recommendation of the study. Such integration could improve symptom management, particularly for patients who report fatigue despite well-controlled inflammation.

This research adds to the growing recognition that fatigue in RA is multifactorial. Given the lack of association between actigraphy-based sleep data and fatigue, clinicians may find greater diagnostic and therapeutic value in patient-reported sleep assessments.

Overall, these findings support a more holistic, patient-centered approach to fatigue management in RA—one that prioritizes subjective sleep quality as a modifiable contributor to a key symptom burden.

Reference
Chalupczak NV, Aydemir B, Isaacs A, et al. Sleep matters: exploring the link between sleep disturbances and fatigue in rheumatoid arthritis. Arthritis Care Res (Hoboken). Published online June 2, 2025. doi:10.1002/acr.25579