Sleep in ankylosing spondylitis and non-radiographic axial spondyloarthritis: associations with disease activity, gender and mood

Introduction:- The study aims were to assess the prevalence of good or poor sleep in a cohort of axial spondyloarthritis patients and to investigate its correlation with a range of objectively and subjectively measured variables in order to develop a model for distinguishing good from poor sleepers . Methods:- Five hundred ninety-eight patients with ankylosing spondylitis and 61 with nonradiographic axial spondyloarthritis completed the Jenkins Sleep Evaluation Questionnaire. Measures of disease activity, mobility, function, mood, fatigue, quality of life, work productivity, night-time pain and general health were gathered. Results:- Patients with ankylosing spondylitis or nonradiographic axial spondyloarthritis were initially compared. With the exception of waking up tired less often and having lower mobility and functioning, the two groups were similar so were combined for subsequent analysis. Twenty-nine percent of all patients were classified as good sleepers and 19% as poor sleepers. Poor sleepers had higher disease activity and fatigue scores and more night-time back pain than good sleepers. They reported poorer quality of life, general health, mood, and work-related measures. A model incorporating mood, gender, fatigue and objective and subjective judgements of disease activity correctly classified 87.3% of good and poor sleepers. Conclusions:- Poor sleep was strongly associated with poor mood, female gender, greater fatigue, greater disease activity (specifically, spinal pain and stiffness) and better mobility, however, the direction of causality between poor sleep and markers of active disease was undetermined. This study also highlights the need to standardise the measurement of sleep disturbance in axSpA to facilitate comparisons between patient groups and interventions

Subacute airway obstruction from a tracheal mucosal flap

We report the case of a 15-year-old girl with a near fatal obstructive tracheal lesion following tracheal intubation. The patient developed stridor and acute respiratory distress 29 h following tracheal extubation, after 35 h intubation in the intensive care unit. The failure of conventional management of stridor, including re-intubation, to provide a satisfactory airway prompted an urgent bronchoscopy, which revealed a tracheal mucosal flap causing 80% obstruction of the subglottic trachea. The fibreoptic bronchoscope allowed careful placement of a tracheal tube distal to the obstruction. The patient eventually made a full recovery. The low incidence of similar lesions and the lack of distinguishing clinical features from other causes of post-extubation stridor make diagnosis and appropriate management of this life-threatening condition difficult. We discuss how early consideration of the diagnosis and optimal initial management reduce the risk of an adverse outcome