Disturbed sleep predicts osteoarthritis knee pain, catastrophizing
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Key takeaways:
- Patients with worse sleep disturbances are more likely to demonstrate knee pain and catastrophizing in those with osteoarthritis.
- Sleep improvements may help improve knee pain.
Patients with knee osteoarthritis who experience sleep disturbances are more likely to experience catastrophizing and worsened knee pain, according to data published in Arthritis Care & Research.
“Sleep disturbance affects approximately 50% of older patients with [knee OA (KOA)],” Yining Wang, BM, of Anhui Medical University, in China, and colleagues wrote. “Previous studies have shown that purely targeting sleep problem only has small effects on pain outcomes. Sleep disturbance and pain-related experiences are closely related, and poor sleep quality can induce unhealthy emotions including catastrophizing.
“However, the associations between sleep disturbance, pain, and catastrophizing, especially the underlying pathways, are to be clarified,” they added. “Several cross-sectional studies have confirmed that catastrophizing or pain were more likely to occur in patients with sleep disturbances.”
To examine the links between sleep disturbances, catastrophizing and knee pain in older and middle-aged adults, Wang and colleagues analyzed data from the Osteoarthritis Initiative (OAI) cohort, which includes patients aged 45 to 79 years with knee OA or who are at an increased risk for developing OA. The analysis included patients who had information available on sleep disturbances and knee pain, or catastrophizing, at baseline.
The researchers measured patients’ sleep quality using the Center for Epidemiologic Studies Depression Scale (CES-D) every 12 months from baseline — which they set at 48 weeks in the OAI cohort — through 96 weeks. The analysis included two outcome measures. The first was catastrophizing, which was assessed each year of the study based on two questions from the Coping Strategies Questionnaire. The scores for the questions were averaged to ascertain the average score on a range of zero through six. The second outcome measure was knee pain, measured using the Western Ontario and McMaster Osteoarthritis Index pain subscale.
The analysis included 3,813 participants. At baseline, 10% of included patients reported catastrophizing while 24% reported knee pain. Overall, patients who demonstrated more severe sleep disturbances were more likely to have knee pain (P < .001), and were more likely to catastrophize (P < .001). In addition, sleep disturbance at baseline was predictive of knee pain (P < .001) and catastrophizing (P < .001).
“Sleep disturbance was associated with the presence and predicted the risk of catastrophizing and knee pain,” Wang and colleagues wrote. “While pain relief may benefit from the integrated management of both sleep problem and catastrophizing, sleep interventions may have a universal and independent effect in preventing incident knee pain, irrespective of catastrophizing.”
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