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IRD AS – Improves sleep

Evidence summary (Updated 2022)

Sleep disturbance can be common in patients with inflammatory rheumatic diseases and in particular axial spondyloarthritis (1). Sleep disturbance is associated with increased pain, disease activity, depression, and anxiety in these patients (2). One randomised controlled trial of 100 patients in Norway showed that high intensity exercise 3 times per week in patients with axial spondyloarthritis can significantly improve sleep quality at 3 months, although this was not sustained at 12 months (3).
Quality of evidence:

Grade C (AxSpA) – Low Quality – Evidence from only a secondary analysis of a single RCT of moderate quality

Strength of recommendation

Grade 2 (AxSpA)- Weak Recommendation – Although low quality evidence, it does show significant benefit with no major adverse risks reported


There is low quality evidence that physical activity and exercise interventions can improve sleep quality in patients with AxSpA .


  1. Hultgren S, Broman JE, Gudbjörnsson B, Hetta J, Lindqvist U. Sleep disturbances in outpatients with ankylosing spondylitis a questionnaire study with gender implications. Scand J Rheumatol. 2000;29(6):365-369.
  2. Li Y, Zhang S, Zhu J, Du X, Huang F. Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study. Arthritis Res Ther. 2012;14(5):R215.
  3. Sveaas SH, Dagfinrud H, Berg IJ, Provan SA, Johansen MW, Pedersen E, et al. High-Intensity Exercise Improves Fatigue, Sleep, and Mood in Patients With Axial Spondyloarthritis: Secondary Analysis of a Randomized Controlled Trial. Phys Ther [Internet]. 2020;100(8):1323–32. Available from: