Predictors of Health-Related Quality of Life in Indonesian Women with Systemic Lupus Erythematosus: A Cross-Sectional Within-Cohort Analysis

Predictors of Health-Related Quality of Life in Indonesian Women with Systemic Lupus Erythematosus: A Cross-Sectional Within-Cohort Analysis ObjectiveThis study aims to determine the effects of sleep quality along with age, marital status, socioeconomic status, depression, anxiety, disease activity, pain scale, and dose of corticosteroids on quality of life in women with SLE. MethodsVariables were assessed in 75 women with SLE using the Pittsburgh Sleep Quality Index (PSQI), Lupus Quality of Life (Lupus QoL), Depression, Anxiety, and Stress Scale-21 (DASS-21), and Mexican SLE Disease Activity Index (MEX-SLEDAI). Bivariate and multivariate analyses were performed to determine contributors to quality of life. ResultsOf 75 subjects, 35 (46.7%) patients had poor sleep quality. The mean QoL score for patients is 84.27. Poor sleepers had impaired QoL in physical health (p = 0.003), emotional health (p = 0.007), pain (p = 0.003), and planning (p = 0.006), with fatigue (p < 0.0001) as the most significantly impaired. Younger age (Mean {+/-} SD = 81.1 {+/-} 12.67; p = 0.014) and anxiety or depression (Mean {+/-} SD = 56.66 {+/-} 8.17; p = 0.006) were significantly associated with lower quality-of-life scores. The linear regression results showed an R-squared of 0.361, with anxiety ({beta} = 21.402), sleep quality ({beta} = 8.392), and age ({beta} = 5.526) as the most significant variables. Marital status, socioeconomic status, disease activity, pain scale, and corticosteroid dose did not correlate with QoL. ConclusionPoor sleep quality, anxiety, and younger age were significant independent predictors of lower QoL in women with SLE, explaining 36.1% of the variance. These findings suggest that psychosocial and sleep interventions are crucial for improving well-being in this population, potentially more so than focusing solely on disease activity. Summary Box: Key MessagesO_ST_ABSWhat is already known on this topic?C_ST_ABSO_LISystemic Lupus Erythematosus (SLE) significantly diminishes health-related quality of life (HRQoL), particularly in Asian populations where severe organ involvement is more prevalent. C_LIO_LISleep disturbances affect a large majority of SLE patients globally (approximately 62%) and are closely linked to psychological distress and fatigue. C_LIO_LITraditional management focuses heavily on controlling systemic disease activity and organ damage, yet these clinical markers often correlate poorly with patient-reported well-being3. C_LI What does this study add?O_LIIn this cohort of Indonesian women with SLE, nearly half (46.7%) reported poor sleep quality. C_LIO_LIMultivariate analysis identified anxiety/depression ({beta} = -21.402), poor sleep quality ({beta} = - 8.392), and younger age ({beta} = 5.526) as the most significant independent predictors of lower HRQoL, collectively explaining 36.1% of the variance. C_LIO_LIFatigue was identified as the HRQoL domain most severely impaired by poor sleep quality. C_LIO_LINotably, in patients with predominantly low disease activity, markers like the MEX-SLEDAI and corticosteroid dose did not significantly impact HRQoL, highlighting a "disconnect" between clinical control and patient-perceived health. C_LI How might this study affect clinical practice?O_LIThe findings advocate for a shift in the SLE management paradigm from purely inflammatory control toward a multidisciplinary approach that includes routine screening for sleep quality and psychological health. C_LIO_LIClinicians should prioritize interventions such as Cognitive-Behavioral Therapy for Insomnia (CBT-I) and anxiety management, especially for younger patients who may experience greater disruption to life milestones. C_LI