Prevalence of Sleep Disturbances in Rheumatoid Arthritis and Its Association With Disease Severity: A Hospital-Based Cross-Sectional Observation

Introduction Rheumatoid arthritis (RA), a chronic inflammatory disorder, is associated with significant joint pain, functional disability, and systemic inflammation. Sleep, a vital physiological process, plays a crucial role in immune regulation and tissue repair. Disruptions in sleep patterns are prevalent among RA patients, yet remain underdiagnosed and undertreated. A two-year study investigates the prevalence of sleep disturbances in RA patients and explores the association between pain perception and disease severity. Materials and methods A cross-sectional observational study was conducted from March 2023 to March 2025 in the Departments of General Medicine and Rheumatology at KIMS PBMH, Bhubaneswar. The study included 176 participants, comprising 88 RA patients diagnosed using the 2010 ACR-EULAR Classification criteria and 88 age and sex-matched controls. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with a score ≥5 indicating poor sleep quality. Insomnia severity was evaluated using the Insomnia Severity Index (ISI). RA disease activity was classified using the Disease Activity Score-28 (DAS-28). Pain perception as per the Visual Analogue Scale (VAS) was graded as no pain, mild, moderate or severe. Results Among RA patients, 66 (74.0%) were classified as poor sleepers compared to 5 (5.7%) of controls (p<0.001). Insomnia was prevalent in 67 (76.1%) of RA patients, with 37 (42.0%) experiencing moderate insomnia and 24 (27.3%) severe insomnia (p<0.001). Severe pain was reported by 26 (29.5%) of RA patients versus none in the control group (p<0.001). Disease activity was significantly associated with sleep disturbances: 22 (25%) had mild RA, 38.6% moderate, and 36.4% severe disease activity. Higher DAS-28 scores correlated with poorer sleep quality and increased insomnia severity (p<0.001). Severe pain was a significant determinant of sleep disruption (p<0.001). The findings underscore a strong link between RA, pain, and sleep disturbances. Conclusion Sleep disturbances are highly prevalent in RA patients and strongly correlate with disease severity and pain perception. Routine sleep assessment should be integrated into RA management. Interventions such as cognitive behavioral therapy for insomnia (CBT-I) and pharmacologic treatments targeting both pain and sleep may improve clinical outcomes. Further longitudinal research is warranted to explore causal pathways and the impact of sleep interventions on RA progression.