Impact of Primary Sjogren Syndrome (pSS) on Sexual Life,Quality of Sleep and Chemosensory Function of Female Patients

Abstract

The aim of this study was to assess the impact of primary Sjögren syndrome (pSS) on sexual life, quality of sleep and chemosensory function of female patients. We conducted a thorough search of electronic bibliographic databases including MEDLINE via PubMed, the Cochrane Library and Google Scholar. The search covered studies published from 15 September 2015 to 30 September 2023, using the terms ‘Sjogren’s syndrome’ combined with other relevant keywords. We selected studies based on the PICO model (Population, Intervention, Control, Outcome) and study design criteria. Fourteen articles met our inclusion criteria. The findings indicate that female patients with pSS experience significant impairments in sexual function, sleep quality and chemosensory abilities. Specifically, their sense of smell and taste is often diminished, and these sensory deficits are related to dryness of mucosal surfaces. Additionally, women with pSS frequently suffer from vaginal dryness and painful intercourse, likely due to inflammation and dryness of the vaginal mucosa. Fatigue, a common extra-glandular symptom of pSS, is associated with sleep disturbances, reduced quality of life and functional impairments. This systematic review highlights that female patients with pSS often experience notable impairments in chemosensory functions (both olfactory and gustatory), sexual function and sleep quality.

Keywords

Sjogren’s syndrome sexual dysfunction sleep apnoea hyposmia hypogeusia

Introduction

In the early 1900s, Swedish physician Henrik Sjögren (SHOW-green) first described a group of women whose chronic arthritis was accompanied by dry eyes and dry mouth. Today, rheumatologists know more about the syndrome that is named for Sjögren and—most significantly for patients—can offer advice about how to live with it.¹

Sjögren’s syndrome (SS) is a chronic inflammatory autoimmune disease primarily affecting exocrine glands, such as the salivary and lacrimal glands. It leads to the immune-mediated destruction of these tissues.² SS can occur as a primary condition or as a secondary condition alongside other autoimmune diseases, with rheumatoid arthritis being the most common associated condition. Systemic lupus erythematosus and scleroderma are also linked with secondary SS.³

The syndrome predominantly affects middle-aged adults, with women being nine times more likely to be affected than men, resulting in a male-to-female ratio of about 1:8. The condition is more frequently observed in perimenopausal and postmenopausal women.⁴

Over the past decades, the American European Consensus Group (AECG) criteria, developed and endorsed by the American College of Rheumatology (ACR), have been widely used for classification.⁵ Two key points in these criteria are: (a) Either a positive salivary gland biopsy or the presence of anti-Ro antibodies must confirm the inflammatory and autoimmune nature of the disease, and (b) The criteria account for the systemic nature of SS, including patients who, despite lacking salivary or ocular symptoms, present with extra-glandular manifestations and B cell activation markers.⁶

Typical symptoms of pSS include dry eyes and dry mouth. Patients often experience continuous eye irritation, an unpleasant taste, difficulty eating dry foods and problems with dentures.⁷ Chemosensory disturbances such as reduced or distorted taste and smell are also reported. Additionally, patients may suffer from burning sensations in the tongue or other mucosal surfaces, and halitosis, often associated with reduced salivary secretion and chemosensory disorders.⁸

Sexual function is crucial to quality of life (QoL), and approximately 50% of women with pSS report sexual dysfunction. Key genital symptoms include vulvar and vaginal dryness, dyspareunia (painful intercourse), itching, genital pain and increased susceptibility to infections.⁹ There is limited evidence on the extent to which these symptoms impact sexual function and QoL in pSS patients. Factors influencing sexual function in pSS may include joint pain, age and sex hormones.¹⁰ Musculoskeletal involvement is common in rheumatic diseases, but internal organ involvement can also affect various life aspects, including social, economic, psychological and sexual functions.¹¹

Fatigue affects about 70% of pSS patients and is a significant cause of dysfunction.¹² Individuals with pSS experience sleep disturbances more frequently than healthy people of similar age and gender. Pain, fatigue and depression are often linked with poor sleep quality.¹³ Psycho-cognitive symptoms, such as memory lapses, forgetfulness, mental confusion and diminished concentration, can also occur and negatively impact health-related quality of life (HR-QOL).¹⁴ This will negatively affect the HR-QOL. However, there is limited evidence on the burden of psycho-cognitive symptoms and their impact on the health system.¹⁵

A systematic review has examined the associations between pSS and impacts on smell, taste, sexual function and QoL in female patients. This review assessed the effects of mucosal dryness on these senses and its impact on HR-QOL. A limitation of the study was the lack of primary research, which hindered the exploration of heterogeneity.¹⁶

The relationship between mucosal dryness, chemosensory disturbances, sexual dysfunction and poor sleep quality in pSS is not fully understood. Therefore, this study aims to determine the impact of pSS on sexual life, sleep quality and chemosensory function in female patients.

Methods

Protocol and Registration

The present systematic review was registered at the National Institute for Health Research PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD42023472493). This study followed the (PRISMA 2020) Preferred Reporting Items for Systematic Review 2020.¹⁷

Data Sources and Search Strategy

The following keywords and Medical Subject Headings (MeSH) terms were used in combination with Boolean operators in the advanced search option. The search was conducted across several electronic bibliographic databases, including MEDLINE via PubMed, Cochrane Library, Embase and Google Scholar. Additionally, related journals, books and bibliographies were screened through electronic searches. Only articles published in English were considered. The search was limited to studies published between September 2015 and August 2023. The keywords used were ‘Sjogren’s Syndrome’, ‘Sexual Dysfunction’, ‘Dyspareunia’, ‘Sjogren’s syndrome and gynaecological issues’, ‘Anosmia’, ‘Hyposmia’, ‘Ageusia’, ‘Hypogeusia’ and ‘Sleep apnea’.

Study Selection

The selection of studies was conducted according to the participants, interventions, comparisons, outcome and study design (PICOS) recommendations.

Eligibility Criteria

Table 1.

Inclusion and Exclusion Criteria of Included Participants, Interventions, Comparators, Outcomes (PICO) and Study Design(S).

Inclusion	Exclusion
Participants (P): • Studies published till 31/08/2023 • Studies published in English language with full text articles • Studies with female patient having PSS only • following AECG (American-European Consensus Group classification criteria) to categorise pSS • Studies must compare data from pSS groups to non-pSS control data base groups • Studies that do not have a clear control group, provided the methodology is robust and suitable for answering the research questions Intervention (I): 1. The sexual function of female assessed using the Female Sexual Function Index (FSFI) 2. Sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI) Control(C): Sexual function, sleep quality and chemosensory function in healthy control of same age and sex will be evaluated Outcomes (O): Main outcomes: Impact of pSS on sexual life, quality of sleep and chemosensory function in female patients	• Studies not fully available in the database • In-vitro and animal studies • Studies not mentioning sample size • Studies in which pSS diagnosed based on clinical or other diagnostic criteria

Inclusion

Exclusion

Participants (P):
• Studies published till 31/08/2023
• Studies published in English language with full text articles
• Studies with female patient having PSS only
• following AECG (American-European Consensus Group classification criteria) to categorise pSS
• Studies must compare data from pSS groups to non-pSS control data base groups
• Studies that do not have a clear control group, provided the methodology is robust and suitable for answering the research questions
Intervention (I):
1. The sexual function of female assessed using the Female Sexual Function Index (FSFI)
2. Sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI)
Control(C): Sexual function, sleep quality and chemosensory function in healthy control of same age and sex will be evaluated
Outcomes (O):
Main outcomes:
Impact of pSS on sexual life, quality of sleep and chemosensory function in female patients

• Studies not fully available in the database
• In-vitro and animal studies
• Studies not mentioning sample size
• Studies in which pSS diagnosed based on clinical or other diagnostic criteria

Data Extraction

All searched articles were screened by two independent authors for determining whether the inclusion and exclusion criteria were met. The discrepancy was resolved by discussion with the third author. Data on the author, year of publication, country/region where the trial was conducted, sample size, study design, age group of participants, screening/intervention, primary outcome and secondary outcome (if any) were extracted.

Critical Appraisal of Retrieved Studies (Risk of Bias)

Two authors (A and B) independently evaluated the methodological quality and risk of bias for each study using the 11-item checklist developed by the Agency for Healthcare Research and Quality (AHRQ), which is suitable for cross-sectional studies. Each item was marked as ‘YES’, ‘NO’ or ‘UNCLEAR’, with a ‘YES’ response earning 1 point and the other responses receiving 0 points. Based on the total score, studies were categorised as low quality (0–3 points), moderate quality (4–7 points) or high quality (8–11 points). Any disagreements or inconsistencies were resolved by consulting a third author.¹⁸

Synthesis of Results

Literature Search and Study Selection

Final searches were conducted between 23 July and 23 August. Studies published between year September 2015 and August 2023 will be evaluated. An initial search yielded 9,205 articles. Upon screening titles and/or abstracts, no studies were found that investigated the combined impact of dryness on all four aspects—sexual function, sleep and chemosensory function—in patients with SS. As a result, the search strategy was refined to examine the effects of pSS on each of these elements individually, as well as its influence on overall QoL and mental health. A total of 356 studies were identified as potentially relevant; however, 340 were excluded due to reasons such as the absence of female participants or lack of a comparator group. Sixteen studies were selected for full-text review, and ultimately, 14 met the inclusion criteria and were included in the qualitative analysis.

Study Characteristics

The review includes 14 studies. Specifically, five studies examine the impact of pSS on sexual function, another five explore its effects on chemosensory function (both olfactory and gustatory) and four studies assess its impact on sleep quality. Most of these studies are cross-sectional in design. For diagnosing pSS, all studies follow the AECG classification criteria. Participants in these studies range in age from 18 to 70 years, with all studies exclusively including female participants. The subjective assessment of various parameters was performed using the visual analogue scale (VAS), which ranges from 0 to 10. Objective assessments for chemosensory function were conducted using Sniffin’ Sticks for olfactory testing and taste strips for gustatory evaluation. Female sexual function was consistently measured using the Female Sexual Function Index (FSFI) across all relevant studies. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) in the four studies that focused on this aspect. Additionally, the impact of pSS on HRQoL was assessed as a secondary outcome in these studies (Tables 2–4).

Chemosensory function (Table 2).

Sexual function (Table 3).

Sleep quality (Table 4).

Quality Assessment of Included Studies

Assessment was done using Crombie’s item using AHRQ Methodology Checklist for Cross-Sectional and Case–Control Study (Tables 5–7) in which most of these studies showed lower risk of bias. However, studies assessing chemosensory function^19–21 showed high-risk category, primarily related to sample representativeness and study design. The studies which assess sexual function^24,25 showed higher risk in the adequacy of data description and sample representativeness²⁸ has area of concern in reporting of response rate, representativeness of the sample and clearly stated aims. The studies which assess sleep function,³² showed lowest risk of bias; however,^29–31 it has at least one high-risk elements in particularly in reporting of response rate and sample representativeness.

Table 2.

Characteristics of the Five Included Studies Assessing Chemosensory Function.

Reference and Country of Publication	Study Design	Participants and Mean Age	Screening Method	Outcome	Summary of Study
Rusthen et al. 2017, Oslo, Norway	Case–control	pSS = 31 Controls = 33 Mean age: 30–80	Sniffin’ Sticks-screening, taste strips, OHIP-14	Impairment of chemosensory function	The mean olfactory and gustatory score and OHRQoL were lower in pSS group than patients
Marianne B. Nesvold et al. 2018, Oslo, Norway	Cross-sectional	pSS = 20 Mean age: 18–70	Sniffin’ Sticks-screening and taste strips, OHIP-14	Impairment of chemosensory function Fifteen patients had an OHIP-14 score ≥8	Olfactory scores classified one as anosmic, nine as hyposmic and ten as normosmic. Gustatory scores classified six as ageusic, four as hypogeusic and ten as normogeusic
Preet Bano Singh et al. 2019, Oslo, Norway	Case control	pSS = 58 Controls= 57	Sniffin’ Sticks- screening and taste strips	Impairment of chemosensory function	The frequency of dysgeusia, burning sensation and halitosis was significantly higher in pSS groups versus controls
Xue et al. 2021, Jiangsu, China	Case control,	pSS = 52 Controls= 52 Mean age: 20–70 years	Computerised Testing (OLFACT-CTM)	Impairment of chemosensory function	Decrease in olfactory function was observed in pSS compared to healthy
Minan Y. Al-Ezzi 2023, London, UK	Cross-sectional	pSS = 65 Controls = 62 Mean age: above 18	Sniffin’ Sticks-screening and taste strips	Impairment of chemosensory function	Smell hypofunction appears to be a clinical manifestation in patients with SS, but it does not seem to be associated with the severity of mucosal dryness or with taste disturbance

Table 3.

Characteristics of the Five Included Studies Assessing Sexual Function.

Reference and Country of Publication	Study Design	Participants and Mean Age	Screening Method	Outcome	Summary of Study
Caglar Yildiz et al. 2017, Turkey	Case–control	pSS = 31 Controls = 27 Mean age: 30–68 years	19-item (FSFI) Female Sexual Function Index	Mean FSFI total score was significantly lower in-patient group than control group	Sexual dysfunction in pSS increases with disease duration
Jolien F. van Nimwegen et al. 2017, Netherland	RCT	pSS = 52	19-item FSFI	Impaired sexual function in pSS	Sexual dysfunction and vaginal dryness are highly prevalent in patients with early, active pSS
M. Gozukucuk et al. 2021, Turkey	Case–control	pSS = 68 Controls = 132 Mean age: 20–70 years	19-item FSFI	The FSFI and QoL-SF 36 scores of the pSS group were significantly lower than those of the control group	The vaginal dryness and dyspareunia can be seen in women with pSS even at a very early age and pSS may increase sexual dysfunction in women as age progresses
Minan Al Ezzi et al. 2022, London, UK	Cross-sectional	pSS = 65 Controls = 62 Mean age: above 18	19-item FSFI	FSFI score decreased significantly pSS patients compared to controls	sexual impairment in pSS significantly compromises patients’ social QoL
Jemma McCready et al. 2023, UK	Cross-sectional	pSS = 98 Mean age: above 18	19-item FSFI	FSFI score decreased significantly pSS patients compared to controls	Postmenopausal women had significantly poorer sexual function than premenopausal women with SS

Table 4.

Characteristics of the Four Included Studies Assessing Sleep Quality.

Reference and Country of Publication	Study Design	Participants/Mean Age	Screening Method	Outcome	Summary of Study
Sang Wan Chaung et al. 2019, Korea	Cross-sectional	pSS = 122 Mean age: 53.0 ± 1.2 years	Pittsburgh Sleep Quality Index (PSQI)	Increased prevalence of sleep disturbances in pSS patients compared with controls	Poor sleep quality is an independent determinant of the unsatisfactory symptom state in pSS
Luciana Paula Dardin et al. 2020, Brazil	Cross-sectional	pSS = 50 Mean age: 56.4	PSQI	Poor sleep quality in pSS compare to Controls	The sleep may have an influence on fatigue, and that there is an association between disease activity and sleep
Kiyoko Miyauchi et al. 2021, Tokyo, Japan	Cross-sectional	pSS = 25 Controls = 17 RA = 10 Mean age: 40–75	PSQI	The prevalence of poor sleepers (PSQI ≥ 6) was 56% in pSS, higher than controls	The presence of sleep disturbances, fatigue, and poor HR-QOL in pSS patients than controls
Burcu Metin Okmen et al. 2021, Bursa, Turkey	Cross-sectional	pSS = 50 Controls = 43 Mean age: 18–75	PSQI	The central sensitisation (CS) increased as sleep disturbance increased, and CS increased as sleep duration decreased	The CS rate was found to be high in patients with pSS, and CS was found to have a negative effect on sleep quality

Chemosensory Function

Subjective evaluations of smell and taste functions were conducted in 226 patients with pSS using a 12-odour pen smell identification test and taste strips, and results were compared with those of 204 healthy controls. A significantly higher percentage of pSS patients exhibited ageusia (19% vs. 0%), hypogeusia (32% vs. 12%), anosmia (13% vs. 0%) and hyposmia (29% vs. 9%) compared to controls. However, no significant correlation was found between smell impairment and the severity of dry mouth or taste sensitivity (r = 0.05, P = .6).

Sexual Function

Sexual function was assessed using the FSFI in five of the included studies. In each of these, the mean FSFI scores were significantly lower in the pSS group compared to the control group (P < .05). Furthermore, five of the six FSFI domains—arousal, lubrication, orgasm, satisfaction and pain—were markedly reduced in patients with pSS. Total FSFI scores and all subscale scores, except for pain, showed a negative correlation with the duration of the disease. Sexual dysfunction was consistently associated with reduced QoL and mental well-being in pSS patients, with the most pronounced impact observed on social life quality (β = 0.7, P = .02).

Sleep Function

The subjective assessment was done using PSQI. Included studies showed that 63.5% of pSS patients had PSQI score > 5 indicative of poor sleep quality. There was higher VAS level of overall eye dryness, arthralgia, eyeball pain in Sjogren syndrome Comparison of the PSQI scores of the patients with pSS and the healthy controls revealed a statistically significant difference in favour of the healthy control group in all parameters except duration of sleep and daily function (P < .05).

Discussion

The interplay between mucosal dryness, chemosensory disturbances, sexual dysfunction, poor sleep quality is not fully understood in pSS. The main objective of this review is to systematically evaluate the impact of mucosal dryness on the sensory functions affected by this condition in patients with SS. Thus, we aimed to determine the impact of pSS on sexual life, quality of sleep and chemosensory function of female patients.

Table 5.

Risk of Bias Assessment of Chemosensory Function Using AHRQ’s Methodology.

Studies (Year)	Appropriateness of Design to Meet Aims	Adequate Description of Data	Reporting of Response Rate	Representative of Sample to Total	Clearly Stated Aims and Likelihood of Reliable & Valid Measurements	Assessment of Statistical Significance	Statistical Method Used
Rusthen et al. 2017
Marianne B. Nesvold et al. 2018
Preet Bano Singh et al. 2019
Xue et al. 2021
Minan Y. Al-Ezzi et al. 2023

Note: +/green colour: low risk of bias; ?/yellow colour: some concerns; −/red colour: high risk of bias (Assessment done using Crombie’s item using AHRQ Methodology Checklist for Cross-Sectional Study).

This review included fourteen studies,^19–33 of which five assess chemosensory function, other five assess sexual function and remaining four assess sleep quality in pSS patients.

Out of five studies^19–23 assessing chemosensory function in pSS, two were case–control and three were cross-sectional, involving a total of 430 participants in the age range of 18–70 years. Subjective assessments of smell and taste were conducted using a VAS, ranging from 0 (no disturbances) to 10 (severe disturbances). For objective smell assessment, researchers used an identification test with 12 odour pens (Sniffin’ Sticks-Screening; Burghart Messtechnik, Wedel, Germany), while gustatory function was evaluated using taste strips. The mean olfactory and gustatory scores were lower in pSS patients, while the Oral Health Impact Profile (OHIP-14) scores were higher, indicating a deterioration in oral health-related quality of life (OHRQoL). Gustatory testing identified significantly more patients with pSS as ageusic (lack of taste) or hypogeusic (reduced taste sensitivity) compared to controls, with fewer patients having a normal sense of taste. Similarly, olfactory testing revealed a higher prevalence of anosmia (loss of smell) and hyposmia (reduced smell) among pSS patients. Additionally, patients with pSS reported a significantly higher frequency of BST (burning sensation in tongue) than did controls (54.8% vs. 6.1%).²¹ Notably, pSS patients also showed a higher intake of fat and a lower intake of carbohydrates. This increased fat consumption may serve a lubricating effect in the oral cavity, assisting with mastication and swallowing.²⁰

The European League Against Rheumatism (EULAR) Sjögren’s Syndrome Patient Reported Index (ESSPRI) and EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) showed negative effect on olfactory score. Although dryness of the mucosal membranes was not the key indicative factor for smell impairment.^21,22 A strong positive relationship was observed between olfactory and gustatory functions, though the ability to smell did not serve as a reliable indicator of taste sensitivity.²³

Table 6.

Risk of Bias Assessment of Sexual Function Using AHRQ’s Methodology.

Studies (Year)	Appropriateness of Design to Meet Aims	Adequate Description of Data	Reporting of Response Rate	Representative of Sample to Total	Clearly Stated Aims and Likelihood of Reliable and Valid Measurements	Assessment of Statistical Significance	Statistical Method Used
Caglar Yildiz et al. 2017
Jolien F. van Nimwegen et al. 2017
M. Gozukucuk et al. 2021
Minan Al Ezzi et al. 2022
Jemma McCready et al. 2023

In a review of five studies^24–28 involving 535 adult women (314 cases and 273 controls), sexual function was assessed using the 19-item FSFI. The FSFI assesses six aspects of sexual function—desire, arousal, lubrication, orgasm, satisfaction and pain. A score of ≤26.55 indicates a risk of sexual dysfunction. The pSS group showed notably lower average FSFI scores compared to the control group, with significant reductions observed in five domains: arousal, lubrication, orgasm, satisfaction and pain. Except for the pain domain, FSFI scores demonstrated a negative correlation with the duration of the disease.²⁴ Sexual dysfunction in pSS was linked to factors such as age, vaginal dryness, low sexual desire, dyspareunia and higher ESSPRI scores.²⁵ Increased vaginal dryness likely results from the autoimmune nature of pSS and the stress of chronic illness.¹¹ Notably, sexual function and frequency of intercourse did not correlate with vaginal dryness severity.²⁶ The postmenopausal women with SS had significantly poorer sexual function (total FSFI score) than premenopausal women with SS. The depression and anxiety scores were seen to be significantly higher in pSS group that did control deteriorating the QoL.^27,28

Pertaining sleep disturbances, four cross-sectional studies.^29–32 In a review of four cross-sectional studies involving 237 participants (average age 56.4 years, mostly female), sleep disturbances were evaluated using the PSQI. This self-reported questionnaire consists of 19 questions covering seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication and daytime dysfunction. Total scores range from 0 to 21, with a cutoff of 8.5 indicating poor sleep quality. Scores ≥ 5 represent poor sleep quality and scores ≤ 4 represent good sleep quality.^29,30 The pSS group had significantly higher PSQI scores than controls, highlighting a clear link between sleep disturbances and SS. The poor sleepers reported greater eye dryness, arthralgia and eyeball pain, as well as increased fatigue and depression.³¹ No correlations were found between PSQI scores and ESSDAI or symptom duration. However, actigraphy showed that higher ESSDAI scores were associated with longer periods of nightly awakenings.³²

Table 7.

Risk of Bias Assessment of Sleep Quality Using AHRQ’s Methodology.

Studies (Year)	Appropriateness of Design to Meet Aims	Adequate Description of Data	Reporting of Response Rate	Representative of Sample to Total	Clearly stated Aims and Likelihood of Reliable and Valid Measurements	Assessment of Statistical Significance	Statistical Method Used
Sang Wan Chaung et al. 2019
Luciana Paula Dardin et al. 2020
Kiyoko Miyauchi et al. 2021
Burcu Metin Okmen et al. 2021

Notes: +/green colour: low risk of bias; ?/yellow colour: some concerns; −/red colour: high risk of bias (Assessment done using Crombie’s item using AHRQ Methodology Checklist for Cross-Sectional Study).

This systematic review highlights that mucosal dryness contributes to diminished taste and smell, vaginal dryness, painful intercourse and poor sleep. Fatigue and sleep disturbances are common in pSS and negatively affect overall well-being and QoL. However, further research is required to identify which specific factors have the greatest impact on patients’ overall well-being.

Future studies should focus on identifying the mechanisms through which mucosal dryness contributes to chemosensory dysfunction, sexual dysfunction and sleep disturbances in pSS patients. Longitudinal research is needed to determine whether early diagnosis and targeted interventions can improve the QoL in these patients.

Limitations

Smaller number of studies with less sample size: The review includes a limited number of studies with relatively small sample sizes, which restrict the generalisability of the findings.

High risk of bias: Some included studies had methodological flaws, such as inadequate sample representation and incomplete data descriptions, leading to a high risk of bias.

Selection bias: Selection bias in recruiting participants may have influenced the outcomes, as the included studies did not always have well-balanced or representative samples.

Heterogeneity: Differences in study designs, assessment methods and participant characteristics contributed to heterogeneity, making it difficult to compare results consistently.

Strength

The strength of the current review lies in its methodology that was conducted in accordance with PRISMA guidelines, to ensure high quality of studies selection and data extraction. The included studies had similarity in screening method, and for this method future meta-analysis of this review will be possible.

Conclusion

In conclusion, this systematic review demonstrated that patients with pSS had impaired chemosensory (olfactory and gustatory), sexual function and sleep quality. Impaired chemosensory function could again adversely affect the OHRQoL. However, the impaired sexual function and sleep disturbances had impact on patients’ well-being. Also, clinical management of female patients with pSS should cover the assessment of their sexual functionality and take the necessary precautions to maintain satisfactory QoL and treatment outcome.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethical Statement

Ethical permission was not applicable for this article, as this is a review article drafted from various research articles and not from patients directly.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Patient Consent

Consent was not applicable, as this is a review article compiled from various research articles and guidelines and not from patients directly.

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Impact of Primary Sjogren Syndrome (pSS) on Sexual Life,Quality of Sleep and Chemosensory Function of Female Patients—A Systematic Review

Abstract

Keywords

Introduction

Methods

Protocol and Registration

Data Sources and Search Strategy

Study Selection

Eligibility Criteria

Data Extraction

Critical Appraisal of Retrieved Studies (Risk of Bias)

Synthesis of Results

Literature Search and Study Selection

Study Characteristics

Quality Assessment of Included Studies

Chemosensory Function

Sexual Function

Sleep Function

Discussion

Limitations

Strength

Conclusion

Footnotes

Declaration of Conflicting Interests

Ethical Statement

Funding

Patient Consent

References