Volume 29, Issue 160, June 2025

Sleep Disorders in Autoimmune Diseases: A Literature Review Across Rheumatoid Arthritis, Lupus, and Psoriasis

Sandra Prolejko^1♦, Weronika Kotnis¹, Jan Siemianowski², Weronika Buczek³, Magdalena Pawlak², Justyna Kopala⁴, Błażej Gajęcki², Greta Steć², Agata Brzyska², Tomasz Kucharski⁵

¹Medical University of Lodz, Kościuszki 4, 90-419 Lodz, Poland
²Central Clinical Hospital of Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland
³Pope John Paul II Independent Public Regional Hospital in Zamosc, ul. Aleje Jana Pawła II 10, 22-400 Zamosc, Poland
⁴University Clinical Hospital No.2 of the Medical University of Lodz, Żeromskiego 113, 90-549 Lodz, Poland
⁵Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland

^♦Corresponding author
Sandra Prolejko, ul. Królowej Śniegu 30, 71-799 Szczecin, Poland

ABSTRACT

Sleep disturbances commonly affect autoimmune diseases including, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis. The evidence now shows that poor sleep not only reflects the disease burden but also actively modulates immune responses and influences the disease progression. This review aims to integrate both mechanistic and clinical evidence that links disordered sleep and circadian rhythm disruption to autoimmune pathophysiology. Sleep deprivation and circadian misalignment alter cytokine expression (including IL-6, TNF-α, and interferons) while also affecting T cell differentiation and neuroendocrine signaling. These shifts contribute to chronic inflammation, autoantibody production, and symptom exacerbation across disease contexts. In RA, disrupted cortisol and melatonin rhythms correlate with early morning flares and heightened inflammatory tone. In SLE, fatigue and mood disturbances are often more closely tied to poor sleep than disease activity. Psoriatic patients report substantial sleep impairment due to pruritus, comorbid obstructive sleep apnea (OSA), and mood-related comorbidities. Despite this, sleep assessments remain rare in routine care. Behavioral interventions such as cognitive behavioral therapy for insomnia (CBT-I) show promise for improving outcomes but remain underutilized. Greater clinical integration of sleep management may offer new strategies to mitigate disease burden and improve patient quality of life.

Keywords: sleep disorders, autoimmune disease, circadian rhythm, rheumatoid arthritis, systemic lupus erythematosus, psoriasis, inflammation, cognitive behavioral therapy

Medical Science, 2025, 29, e90ms3600

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DOI: https://doi.org/10.54905/disssi.v29i160.e90ms3600

Published: 25 June 2025