Psychological comorbidities associated with subclinical atherosclerosis in Greek patients with primary Sjögren's syndrome: a potential contribution of sleep impairment.

OBJECTIVES: Impaired sleep and psychological disorders are increasingly recognised as prevalent comorbidities in patients with primary Sjögren's syndrome (pSS), as well as important contributors of atherosclerosis in the general population. In the current study we sought to explore a potential role of psychological comorbidities in the pronounced atherosclerotic risk of pSS patients.

METHODS: Fifty-nine pSS patients fulfilling the ACR/EULAR criteria completed specific validated questionnaires assessing fatigue, depression, anxiety and sleep disturbances. Clinical, laboratory and histopathological characteristics together with traditional risk factors for atherosclerosis were documented in all enrolled patients. Subclinical atherosclerosis defined either as carotid and/or femoral plaque formation or increased intima media thickness (IMT) levels were assessed by Doppler ultrasound. Univariate and multivariate analysis were performed.

RESULTS: Plaque formation and high IMT levels were detected by ultrasound in 41(69.5%) out of the 59 pSS patients. In univariate analysis, age and higher triglyceride serum levels were associated with both plaque formation and high IMT levels. Hypertension was associated only with high IMT levels. While increased rates of both state anxiety and impaired sleep were detected in pSS patients with plaque formation in a univariate model, only impaired sleep proved to be independently associated with plaque formation among pSS patients (OR = 4.2, 95% CI =1.1-15.6, p=0.03).

CONCLUSIONS: This is the first study showing impaired sleep to confer a significantly higher risk of subclinical atherosclerosis in patients with pSS. Clinicians should take psychological disturbances into account when trying to assess and manage the cardiovascular disease risk of pSS patients.