Effects of home exercise program on sleep disturbances, function and quality of life on patients with spondyloarthritis

Objectives: Spondyloarthritis (SpA) is a group of diseases characterized by common clinical signs and symptoms, characterized by genetic predisposition, which may be characterized by inflammation and sacroiliitis and peripheral joints, mainly in the axial skeleton and sacroiliac joints. Sleep problems are often seen in patients, and patients are asked to improve sleep quality the most, after pain. Methods: We have included 100 patients classified as SpA according to the ASAS / EULAR criteria who applied between 01 November 2016 and 31 July 2017, at Manisa Celal Bayar University Hafsa Sultan Hospital Department of Physical Medicine and Rehabilitation Policlinics. Patients were initially assessed for sleep quality (PSQI), fatigue (FSS), quality of life (ASQoL), disease activity (BASDAI) and functional status (BASFI). Then this group divided into two subgroups randomly and one of this groups treated with exercises consisting mainly of flexibility, mobility and posture exercises, in addition to the existing medical treatments. Exercise program was applied as a 12-week home program with minimum 2 day/week frequency. Control group continued with current medical treatment. They received exercise program after 12th week assesment. Results: We found poor sleep quality in 74% of SpA patients and 26.7% of healthy volunteers (p = 0.000). When we evaluate sleep quality with the PSQI, all other domains except for daytime dysfunction (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep medication requirements) have shown that impaired in a statistically significant manner when compared to healthy volunteers. (sleeping pills p = 0.038 for other parameters, p = 0.000 for other parameters). We did not find a significant difference in sleep quality and fatigue between the AS and the Nraks-SpA within the SpA group. We also found no difference between this two disease groups in the domains of the PSQI. Sleep quality was the most strongly related with quality of life, followed by disease activity and pain, respectively. Via 12 weeks flexibility, posture and mobilization home exercise program, we achieved significantly improved sleep quality, fatique, functional status and quality of life parameters when compared to the control group. (P = 0.000, p = 0.002, p = 0.011, p = 0.004, respectively). Both of the groups improved disease activity (BASDAI) after 12 weeks. Conclusion: Sleep quality in SpA patients is markedly impaired and these patients feel fatique more than healthy population. There is no difference between AS and nraks-SpA patients for sleep quality and fatique assesment. 12 weeks home exercise program which consists flexibility, mobilization and posture exercises mainly are effective in the treatment of this problems.