Long-term hydroxychloroquine therapy improves the quality of sleep in patients with primary Sjogren's syndrome: a real-world study

Background: Patients with primary Sjogren's syndrome (pSS) often suffer from sleep disturbance. Studies suggest it may be related to symptoms, including xerostomia and dry eyes. Clinical studies have confirmed that hydroxychloroquine (HCQ) has a definite effect on pSS, but there is no clear report about its effect on sleep disorders in pSS patients. Methods: A total of 383 pSS patients were enrolled and followed up. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality of the patients, and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) scale was used to evaluate the quality of life (QoL) of patients. The European League assessed the patient's condition against Rheumatism Sjogren's syndrome patients reported index (ESSPRI). According to PSQI, patients were divided into two groups: good sleep group (GSG) and poor sleep group (PSG). The risk factors of sleep disorder are analyzed by univariate and multivariate analysis. The patients were further divided into HCQ-administered group and non-administered group, and the differences of baseline characteristics and outcome in follow-up between the two groups were compared. Results: There were 208 patients with PSG (54.3%) and 175 patients with GSG (45.7%). Further, there is no statistical difference between the two groups in baseline data. Also, there were 112 cases (53.8%) and 118 cases (67.4%) taking HCQ in the two groups, respectively, P=0.007. Univariate and multivariate analysis showed that long-term use of HCQ, menopause, and income were related to sleep quality. The patients were divided into the HCQ-administered group (n=230) and non-administered group (n=153) according to whether they took HCQ. One hundred eighteen patients (51.3%) in the HCQ-administered group had a good sleep, and 58 patients in the non-administered group had a good sleep (37.9%), P<0.05. At follow-up, the PSQI of the two groups were 7.3 +/- 2.1 vs. 8.1 +/- 2.4, respectively, P<0.05 and the ESSPRI were 4.9 +/- 1.1 vs. 5.4 +/- 1.3, P<0.05. The QoL of the two groups of patients was statistically different in all four dimensions, P<0.05. Conclusions: Long-term use of HCQ can reduce the risk of sleep disturbance in patients with primary Sjogren's syndrome.