The relationship between restless sleep and symptoms of the knee: data from the Osteoarthritis Initiative

The associations between sleep problems and pain outcomes in people with hand osteoarthritis - Data from the Nor-hand study

Objective

To examine the relation of sleep problems to pain outcomes in people with hand osteoarthritis, and the extent to which central sensitization mediates these relationships.

Design

In total 299 participants from the Nor-Hand cohort study rated their sleep problems (no, slight, moderate or severe problems), hand pain intensity on a Numeric Rating Scale (NRS, range: 0-10) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN; range: 0-20), and overall bodily pain intensity (NRS). Central sensitization was evaluated by quantitative sensory testing. All pain questionnaires were repeated after 3.5 years. We explored the associations between sleep problems at baseline and pain outcomes at baseline and follow-up and fitted natural effect models to examine the extent to which measures of central sensitization mediated the effects of sleep problems on pain. All main analyses were adjusted for age, sex, education, comorbidities, and body mass index.

Results

Slight, moderate, and severe sleep problems were reported by 33.8 ​%, 26.8 ​% and 14.3 ​%, respectively. In general, individuals with severe versus without sleep problems reported relatively more intense pain at baseline and follow up (i.e., a 1.68 (95 ​% confidence interval 0.89-2.46) higher NRS hand pain at baseline). Associations between sleep and central sensitization were weak, with no mediating effects found. For example, the indirect effect of remote pressure pain thresholds was 0.06 (-0.27, 0.39) NRS points for hand pain among individuals reporting severe sleep problems.

Conclusion

Sleep problems are commonly reported and related to pain intensity in people with hand osteoarthritis, while the underlying mechanisms and temporal relationship remain unclear.

Are Sleep Quality, Daytime Sleepiness, and Depression Associated with Knee Pain? A Cross-Sectional Study in Older Adults

Introduction  Osteoarthritis (OA) is common among older adults, and studies have suggested that it is commonly associated with sleep problems and depression. However, the results are inconsistent concerning overall sleep quality, daytime sleepiness, and depression in studies that consider OA knee pain specifically. Objectives  To examine the relationship between sleep quality, daytime sleepiness and depression, and OA knee pain in older adults. Methods  This was a cross-sectional study. Adults aged 60 and above with OA knee pain according to the National Institute for Health and Care Excellence (NICE) guidelines, and who had preserved cognitive function were recruited. Sleep quality, daytime sleepiness, and depression symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Center for Epidemiologic Studies Depression Scale (CESD), respectively. The generalized linear model (GzLM) approach was used in the statistical analysis. A logistic regression model was performed to evaluate whether ESS, PSQI, and CESD symptoms were associated with knee pain. Results  The sample comprised 451 older adults. Sleep quality (OR = 1.22, 95% confidence interval [CI]: 1.07 to 1.40) and depressive symptoms (OR = 1.09, 95%CI: 1.01 to 1.17) were associated with knee pain, but there was no association with excessive daytime sleepiness (OR= 1.09, 95%CI: 0.90 to 1.20). Conclusions  Sleep quality and depression symptoms are associated with knee pain.

The Knee-SCHOOL: a brief patient-centered multidisciplinary educational program for knee osteoarthritis

Background

Knee osteoarthritis (KOA) is the most common form of arthritis in adults and a leading cause of years lived with disability, representing a significant burden on healthcare worldwide.

Objective

Describe the structure and educational elements of the Knee-SCHOOL, a brief patient-centered multidisciplinary educational program for patients with KOA.

Design

Observational prospective study.

Setting

Academically affiliated rehabilitation outpatient center in Brazil.

Methods

The program consisted of three in-person educational sessions (4.5 hr each) for 55 community dwelling adults, aged ≥50 years, with primary KOA-related pain. Study measures included demographic data (age, sex, and educational level), pain duration (years), pain intensity (visual analogue scale), affected knee (right, left, or both knees), comorbidities (presence of hypertension, diabetes, and hypercholesterolemia), Body Mass Index (BMI), Bristol Stool Scale, Adapted Healthy Eating Index (AHEI), bioelectrical impedance, daytime sleepiness, and the impact of the KOA on pain, symptoms, activities of daily living, recreation, and quality of life. Participants attended educational sessions delivered by a multidisciplinary team (two physicians, two nurses, two physical therapists, one occupational therapist, one dietitian, one psychologist, one social worker, and one physical educator) addressing several aspects of KOA. They also participated in supervised exercise practice and a home exercise program.

Results

Fifty-five subjects completed the study. The mean age was 67.73 (± 7.73) years; most were females (70.9%), 92.7% had bilateral KOA, with mean pain duration of 12.41 (± 10.17) years. The mean BMI was 32.52 (± 5.99), 65.5% were obese, and 96.4% reported an inadequate diet. KOA had a more negative impact on sports, recreation and quality of life. Daytime sleepiness was uncommon. The mean pain intensity, measured with visual analogue scale, score reduced from 5.52 (± 2.11) at baseline to 4.04 (± 2.38) after the program (week 2). The effect size was 0.7 (95% CI 0.32 to 1.07). All participants received the program well, with no drop-out rates or reported adverse events.

Conclusion

The Knee-SCHOOL utilized a multidisciplinary educational approach and an exercise practice addressing multiple aspects of KOA pain. While more studies are needed to assess the longitudinal impact of the program, it was promising in managing pain.

Association between nighttime sleep duration and quality with knee osteoarthritis in middle-aged and older Chinese: A longitudinal cohort study

BACKGROUND

The association between nighttime sleep duration and sleep quality with the risk of knee osteoarthritis (OA) remains unclear. This study aimed to examine the longitudinal association among middle-aged and older adults in China.

METHODS

The data used in this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS) surveys conducted in 2011 and 2015. Nighttime sleep duration was categorized into five groups: <6 h, 6 to <7 h, 7 to <8 h, 8 to <9 h, and ≥9 h/night. Sleep quality was assessed by restless days in the past week (<1, 1-2, 3-4, and 5-7 days/week). Multivariate logistic regression models were used to assess the association between sleep duration and quality with incident knee OA.

RESULTS

A total of 11,114 participants who did not have knee OA at baseline were enrolled in this study. After 4 years of follow-up, the overall incidence of knee OA was 8.07 %. Compared to 7 to <8 h of sleep duration, short sleep duration (<6 h/night) was associated with a significantly increased risk of incident knee OA in the fully adjusted model [odds ratio (OR) =1.73, 95 % confidence interval (CI): 1.33-2.25]. Additionally, participants with 5-7 sleep restless days/week were associated with significantly increased risk of incident knee OA (OR = 1.88, 95 % CI: 1.48-2.38).

CONCLUSIONS

Short nighttime sleep duration and poor sleep quality are associated with increased risk of incident knee OA.

Clinical aspects and outcomes in osteoarthritis

Osteoarthritis (OA) is the most prevalent type of arthritis worldwide, and its incidence significantly increases with age. It commonly affects the knees, hips, spine, big toes, and hands. OA can be identified through clinical examination, symptoms, and imaging methods. Its main symptoms include pain, stiffness, and limitations in joint movement. Examinations may reveal coarse crepitus, bony enlargement, and tenderness at the joint line. In severe cases of OA, rest pain, night pain, and deformity may occur. OA can lead to decreased physical activity, function, and quality of life due to symptoms such as pain and stiffness. To evaluate these impacts, patient-reported outcome measures (PROMs) are necessary. Various generic, disease-specific, and joint-specific PROMs have been developed and used in clinical practice to assess the outcomes of OA.

Prevalence and factors associated with knee osteoarthritis among middle-aged and elderly individuals in rural Tianjin: a population-based cross-sectional study

BACKGROUND

The prevalence of osteoarthritis has been investigated in many countries and regions. Considering the wide differences in ethnicity, socioeconomic status, environmental factors, and lifestyle patterns, our study aimed to report the prevalence of knee osteoarthritis (KOA) and its associated factors in rural areas of Tianjin.

METHODS

This population-based cross-sectional study was conducted between June and August 2020. KOA was diagnosed according to the 1995 American College of Rheumatology criteria. Information on participants' age, years of education, BMI, smoking and drinking status, sleep quality, and frequency of walking were collected. Multivariate logistic regression analysis was used to analyze factors influencing KOA.

RESULTS

This study included 3924 participants (1950 male and 1974 female); the mean age of all participants was 58.53 years. In total, 404 patients were diagnosed with KOA, and the overall prevalence of KOA was 10.3%. The prevalence of KOA was higher in women than in men (14.1% vs. 6.5%). The risk of KOA in women was 1.764 times higher than that in men. The risk of KOA increased following the increasement of age. There was higher risk of KOA in participants who walked frequently than in participants who walked infrequently (OR = 1.572); in participants with overweight than in participants with normal weight (OR = 1.509), in participants with average sleep quality (OR = 1.677) and those with perceived poor sleep quality (OR = 1.978), respectively, than participants with satisfactory sleep quality, and in postmenopausal women than in non-menopausal women (OR = 4.12). The risk of KOA in participants with an elementary level was lower (0.619 times) than participants with illiteracy. In addition, the results of gender subgroup analysis showed that in male, age, obesity, frequent walking and sleep quality were independent factors associated with KOA; while in female, age, BMI, education level, sleep quality, frequent walking and whether menopausal were independent factors associated with KOA (P < 0.05).

CONCLUSION

The results of our population-based cross-sectional study showed that sex, age, educational level, BMI, sleep quality, and frequent walking were independent influencing factors for KOA, and the influencing factors for KOA differed between the sexes. In order to reduce the disease burden of KOA and the harm to the health of middle-aged and elderly people, the risk factors related to the control of KOA should be identified as much as possible.

TRIAL REGISTRATION

ChiCTR2100050140.