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

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Abstract

Objective

To examine the associations between restless sleep and knee symptoms among individuals with radiographically confirmed KOA.

Methods

Cross-sectional and longitudinal associations were examined using Osteoarthritis Initiative (OAI) data. Participants with radiographic KOA (n = 2517) were asked how often sleep was restless in the past week over the 4 years, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to measure knee symptoms. Adjusted β coefficients (aβ) and 95% confidence intervals (CI) were derived from generalized estimating equations (GEEs) models stratified by sex.

Results

One in 7 participants reported ≥ 3 nights with restless sleep. Cross-sectional analyses indicated that restless sleep 5–7 nights was associated with worse symptoms (Women: pain: aβ 1.93, 95% CI 1.12–2.74, stiffness: aβ 0.57, 95% CI 0.19–0.94, physical function: aβ 5.68, 95% CI 3.09-8.27; Men: pain: aβ = 1.85, 95% CI 0.85–2.86; stiffness: aβ 0.63, 95% CI 0.15–1.12; physical function: aβ 5.89, 95% CI 2.68–9.09) compared with < 1 night. Longitudinal analyses confirmed that more nights with restless sleep were associated with worse pain (P trend = 0.01) and function (P trend = 0.04) in women and physical function in men (P trend = 0.04), although estimates did not meet thresholds for minimal clinically meaningful differences.

Conclusion

While the analysis of cross-sectional data supported the association between restless sleep and KOA symptoms, such relationships were not confirmed in more robust longitudinal analysis. Further research examining whether sleep quality, duration, or disorders is associated with worsening symptoms in persons with KOA is warranted.

Key Points

• The prevalence of frequent restless sleep among persons with knee OA is not uncommon.

• There were linear trends between frequency of restless sleep and self-reported symptoms of the knee in cross-sectional analyses.

• In the more robust longitudinal analysis, despite the statistically significant linear trends observed between frequency of restless sleep and symptoms (women: pain and physical function; men: function), none appeared to reach the a priori selected ranges for minimally clinically relevant differences.

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Data availability

The datasets used in the current study are available through the Osteoarthritis Initiative website: https://nda.nih.gov/oai/.

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Funding

This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (grant no. R21AR076641). The OAI is a public-private partnership composed of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer, Inc.

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Authors and Affiliations

  1. Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA

    Kate L. Lapane, Divya Shridharmurthy, Catherine E. Dubé & Shao-Hsien Liu

  2. Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, 01655, USA

    Divya Shridharmurthy

  3. Department of Kinesiology, Michigan State University, East Lansing, MI, 48824, USA

    Matthew S. Harkey

  4. Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, MA, 02111, USA

    Jeffrey B. Driban

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  1. Kate L. Lapane
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Correspondence to Shao-Hsien Liu.

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The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.

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The authors declare that they have no competing interests.

Ethics approval

This study used publicly available data from the OAI and, as such, the University of Massachusetts Institutional Review Board considered this study exempt, and the informed consent was waived.

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Lapane, K.L., Shridharmurthy, D., Harkey, M.S. et al. The relationship between restless sleep and symptoms of the knee: data from the Osteoarthritis Initiative. Clin Rheumatol 40, 2167–2175 (2021). https://doi.org/10.1007/s10067-020-05531-4

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