Individuals with systemic lupus erythematosus (SLE) have reported poor sleep quality, both globally and in China. However, the influencing factors remain unclear and inconsistent. According to Spielman’s Model (3P Model), existing evidence has primarily focused on predisposing and precipitating factors, while perpetuating factors have been under-explored. Thus, this convergent mixed-methods study aimed to explore the predisposing (age, BMI, disease activity), precipitating (fatigue, pain, depression, anxiety), and perpetuating (sleep hygiene practices) factors influencing sleep quality among Chinese SLE persons.

A total of 370 SLE persons were recruited from a tertiary hospital in China. Quantitative data were collected using an online survey consisting of the Chinese version of the Pittsburgh Sleep Quality Index, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Sleep Hygiene Practices Scale, Pain Visual Analogue Scale, and Systemic Lupus Erythematosus Disease Activity Index 2000. For the qualitative part, the data were gathered from 20 participants through semi-structured interviews. Regression analysis addressed the quantitative data, while thematic analysis was used to analyze the qualitative data. 

A total of 325 SLE persons participated in the quantitative data analysis (a response rate of 87.8%), with 209 (64.3%) reporting poor sleep quality. That daytime dysfunction (1.58±0.94) was the most severely affected, followed by longer sleep latency (1.40±0.95), sleep disturbances (1.32±0.64), lower subjective sleep quality (1.26±0.76), shorter sleep duration (1.02±1.00), lower habitual sleep efficiency (0.93±1.15), while the use of sleeping medications was the least affected (0.22±0.71). Hierarchical regression analysis revealed that age (β = 0.193, p<0.001), disease activity (β = 0.095, p = 0.031), fatigue (β = 0.114, p = 0.023), pain (β = 0.180, p = 0.001), anxiety (β = 0.196, p < 0.001), and sleep hygiene practices (β = 0.293, p < 0.001) were significant predictors of poor sleep quality, explaining 43.1% of the variance in sleep quality. The qualitative data organized into 7 main themes and 24 sub-themes, including (1) perception/meaning of sleep quality (appropriate sleep timing and duration, deep and continuous sleep, minimal disturbance during the night, a sense of relaxation during sleep, feeling refreshed and restored after waking), (2) poor sleep experience (difficulty in falling asleep, frequent waking at night, difficulty falling back asleep after waking, insufficient sleep duration and depth, feeling not refreshed after waking in the morning), (3) age-related life stress and perceived decline in sleep quality (accumulation of life responsibilities and cognitive rumination when aging, advancing age causing low-quality sleep), (4) physical symptoms disrupt sleep (active disease-causing physical discomfort disrupts sleep, fatigue-induced sleep initiation problems, physical pain-mediated sleep maintenance disruption), (5) psychosomatic disruption of sleep quality (uncontrollable thoughts before going to bed disrupts sleep, negative emotions disrupt sleep, work and life stress disrupts sleep), (6) medication interference with sleep quality (drug-induced excessive arousal and resistance to falling asleep, drug treatment affects sleep structure), and (7) poor sleep hygiene induced sleep disruption (irregular sleep time disrupts sleep, sleep environments during nighttime disrupt sleeps, behaviors before bedtime impact sleep, dual regulatory effect of napping on sleep). Through the integration of quantitative and qualitative research results, it was found that in terms of sleep quality among Chinese SLE persons, the quantitative and qualitative results were complementary. Regarding the influencing factors of sleep quality, quantitative and qualitative results showed consistency in terms of predisposing factors, and extensibility in terms of precipitating and perpetuating factors. Of particular note is the divergence between statistical significance and experiential significance regarding depression: although it may not exert a strong independent effect at the population level, it may still be meaningful in individuals’ subjective experiences. 

Individuals with SLE experience poor sleep quality, which is influenced by multiple factors across physical, psychological, and behavioral domains. These in-depth insights provide a comprehensive understanding of sleep-related problems in this population and serve as a foundation for addressing physical symptoms, psychological distress, and maladaptive sleep-related behaviors to improve sleep quality among this population.