Nocturnal Knee Pain Increases With the Severity of Knee Osteoarthritis, Disturbing Patient Sleep Quality

Abstract

Objective. Sleep disturbances frequently accompany chronic pain from osteoarthritis (OA). Effective management of sleep disturbances may require successful treatment of chronic pain, a key factor in the clinical evaluation of knee OA. However, the relationship between the severity of knee OA and sleep quality is unclear. Our purpose was to correlate the prevalence of nocturnal knee pain with different OA severity levels and to determine its influence on sleep quality. Methods. Subjects included 1,214 local volunteers with mean ؎ SD age 58.1 ؎ 13.0 years. The existence and severity of knee OA were determined by the Kellgren/Lawrence (K/L) grade, and joint space widths were measured. The presence of nocturnal knee pain and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed by self-completed questionnaires. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index. Knee-related factors affecting sleep quality were detected using statistical methods. Results. The prevalence of nocturnal knee pain was 3.6%, 6.9%, 19.4%, 32.7%, and 75.0% in K/L grades 0, 1, 2, 3, and 4, respectively. Also, prevalence significantly increased with OA severity (P < 0.001). Sleep problems also increased with K/L grade (P ‫؍‬ 0.038), and KOOS quality of life (QOL) was significantly lower in those with OA and sleep problems. Logistic regression showed that sleep problems were related to joint space narrowing (P ‫؍‬ 0.016) and nocturnal knee pain (P ‫؍‬ 0.039). Severe OA also disturbed onset and maintenance of sleep. Conclusion. The prevalence of nocturnal knee pain and sleep problems increased with the severity of OA, impacting QOL. These results suggest the necessity of appropriate nocturnal pain control.

Is Early Prescribing of Opioid and Psychotropic Medications Associated With Delayed Return to Work and Increased Final Workers’ Compensation Cost?

“…15,25,26 Consequently, antidepressant, antianxiety, and hypnotic medications are markers associated with worse outcomes in workers who are at risk for an increased prevalence of depression, anxiety, and sleep disorders, as documented in populations with chronic pain. 17,[27][28][29] There are limitations to this study. We examined prescriptions of opioids and different classes of psychotropic medications, but did not measure the use of these medications.…”

Osteoarthritis year in review 2015: clinical

“…Among other studies dealing with pain, nocturnal knee pain and worse sleep quality were associated with knee OA severity in participants from the Iwaki Health Promotion Project (83). More people with high knee pain/low disease burden of knee OA (vs. high pain/high OA, low pain/high OA, low pain/low OA) had widespread pain, in persons with or at higher risk for knee OA in the Multicenter Osteoarthritis Study (84).…”

Functional imaging in OA: role of imaging in the evaluation of tissue biomechanics

“…OA is often triggered by injury, involving reciprocal actions of joint biomechanics and biochemistry, and advancing through a cascade of degenerative events following inflammation and increased expression of catabolic cytokines and enzymes [10–12]. Advanced OA has been assessed by multiple non-imaging methods, including scoring of pain [13–15], retrieved biopsies [16], and combined (e.g. WOMAC) assessments of pain, joint stiffness and physical function [17–24].…”