Summary
Introduction: Although sleep alterations can be an important factor contributing to the clinical
state of Systemic Lupus Erythematosus, there are no studies to adequately assess sleep
quality in this type of disease.
Objectives: The aim of this work is to analyse the sleep quality of Systemic Lupus Erythematous
(SLE) patients based on more objective information provided by actigraphy and mobile
systems. The idea is to carry out a comprehensive study by analysing how environmental
conditions and factors can affect sleep quality.
Methods: In traditional methods the information for assessing sleep quality is obtained through
questionnaires. In this work, a novel method is proposed by combining these questionnaires
that provide valuable but subjective information with actigraphy and a mobile system
to collect more objective information about the patient and their environment. The
method provides mechanisms to detect how sleep hygiene could be associated directly
with the sleep quality of the subjects, in order to provide a custom intervention
to SLE patients. Moreover, this alternative provides ease of use, and non-intrusive
ICT (Information and Communication Technology) through a wristband and a mHealth system.
The mHealth system has been developed for environmental conditions sensing. This consists
of a mobile device with built-in sensors providing input data about the bedroom environment
during sleep, and a set of services of the Environmental Monitoring System for properly
managing the configuration, registration and fusion of those input data. In previous
studies, this information has never been taken into account. However, the information
could be relevant in the case of SLE patients. The sample is composed of 9 women with
SLE and 11 matched controls with a mean age of 35.78 and 32.18, respectively. Demographic
and clinical variables between SLE patients and healthy controls are compared using
the Fisher exact test and the Mann-Whitney U test. Relationships between psychological
variables, actigraphy measures, and variables related to environmental conditions
are analysed with Spearman’s rank correlation coefficient.
Results: The SLE group showed poorer sleep quality, and more pain intensity, fatigue and depression
than the healthy controls. Significant differences between SLE women and healthy controls
in measures of actigraphy were not found. However, the fusion of the measures of the
environmental conditions that were collected by the mobile system and actigraphy,
has shown that light, and more specifically temperature have a direct relation with
several measures of actigraphy which are related to sleep quality. It should be emphasize
this result because usually the sleep problems are assessment through self-reported
measures which had not revealed this association. Moreover, there are no previous
studies that analyse these aspects in bedroom environments of SLE patients directly
from objective measures.
Conclusions: The results indicate the need to complement the subjective evaluation of sleep with
objective measures. The use of actigraphy in combination with a new mHealth system
provides a complete assessment especially relevant to chronic conditions as SLE. Both
systems incorporate this objective information directly from objective measures in
a non-intrusive way. Moreover, the measures of bedroom environmental variables provide
useful and relevant clinical information to assess what is happening daily and not
occasionally. This could lead to more customized interventions and adapt the treatment
to each individual.
Keywords
Systemic Lupus Erythematosus (SLE) - sleep hygiene - sleep quality - mHealth - monitoring
systems
