Background/Purpose: There is increasing recognition that sleep quality is a key outcome among patients with osteoarthritis (OA), but little is known about how clinical or demographic factors influence sleep quality in patients with OA.  This study examined patient characteristics associated with insomnia and sleep apnea among patients with hip and knee OA. 

Methods: Participants were 300 veterans enrolled in a clinical trial examining a patient and provider intervention for managing OA at the Durham Veterans Affairs Medical Center (mean age = 61, SD=9, 91% male, 50% non-white – primarily African American). All measures were obtained from a baseline interview.  Self-reported sleep problems were assessed with the Insomnia Severity Index (ISI; range of 0-28, higher scores indicate more severe insomnia) and the Berlin Questionnaire (BQ; categorizes patients as “high risk” or “low risk” of having sleep apnea).  We fit multivariable linear (ISI) and logistic (BQ) regression models to examine the associations of the following patient characteristics with insomnia and sleep apnea:  age, gender, race (white vs. non-white), self-reported general health (excellent, very good, good vs. fair, poor), body mass index (BMI), diagnosis of post-traumatic stress disorder (PTSD), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, depressive symptoms (Patient Health Questionnaire-8), and number of joints affected by arthritis.

Results: The mean ISI score was 11.4 (SD = 8.0); this value is slightly above the cut-point for detecting insomnia. 66% of participants were categorized as being at high risk for sleep apnea based on the BQ.  In the multivariable model of ISI scores, factors associated with more insomnia symptoms included younger age (b = -0.09, 95% Confidence Interval (CI) = -0.16, -0.02; p=0.01), PTSD diagnosis (b = 1.68, 95% CI = 0.26, 3.09; p=0.02), higher WOMAC pain score (b = 0.37, 95% CI = 0.18, 0.55; p<0.001), and more depressive symptoms (b = 0.85, 95% CI = 0.71, 0.98; p<0.001).  The only variables associated with high risk for sleep apnea in the multivariable model were greater BMI (odds ratio = 1.13, 95% CI = 1.06-1.21; p<0.001)) and more depressive symptoms (odds ratio = 1.13, 95% CI = 1.06-1.20; p<0.001).

Conclusion: Sleep problems, particularly apnea symptoms, were very common in this sample of patients with hip and knee OA.  Depressive symptoms were associated with symptoms of both insomnia and sleep apnea, but other patient characteristics associated with symptoms of insomnia vs. apnea were different.  These results highlight the importance of screening for both insomnia and sleep apnea among patients with OA, particularly among those who may be at greater risk due to factors such as depression, PTSD, greater pain severity, and high BMI.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-characteristics-associated-with-insomnia-and-sleep-apnea-in-knee-and-hip-oa/