Tossing and turning with degenerative arthropathy: an assessment of poor sleep quality in knee osteoarthritis

Abstract

ObjectivesTo determine the frequency and predictors of sleep abnormalities among patients with knee osteoarthritis (OA) in Nigeria.Material and methodsA multi-centre, hospital-based, cross-sectional study, involving 250 knee OA patients. Consenting patients 18 years and above, who satisfied the American College of Rheumatology (ACR) criteria for knee OA were recruited from five Nigerian tertiary centres over 3 months. An interviewer-administered questionnaire was used to collect demographic and relevant clinical information. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality with scores ≥ 5 indicating poor sleep. Other variables assessed were pain, depression, functional class and family functioning. Data were summarized using appropriate measures of central tendency and dispersion. Multiple logistic regression analysis was done to identify predictors of poor sleep. Analysis was done using SPSS version 21.0 with p < 0.05 considered significant. Study approval was obtained from the ethical committees of each of the study sites.ResultsParticipants included 209 females (83.6%) with mean age 59.9 ±10.6 years. One hundred and forty-one participants (56.4%) had PSQI scores ≥ 5 (poor sleep). This was significantly associated with depression (p < 0.001), level of education (p = 0.001), higher pain scores (p < 0.001), body mass index (p = 0.040), medial knee OA (p = 0.032) and patello-femoral OA (p = 0.002). Higher level of education, worse depression scores and higher WOMAC pain scores were the best predictors of poor sleep quality.ConclusionSleep quality was poor in over half of our knee OA patients and best predicted by depression, pain and level of education. Regular sleep quality assessment for knee OA patients is recommended.

Assessing the Burden of Osteoarthritis in Africa and the Middle East: A Rapid Evidence Assessment

“… 29 Two studies from Nigeria reported the same patient population of men and women ≥18 years of age with knee OA who were assessed according to whether they had depression 13 or poor sleep quality. 14 WOMAC pain subscale scores were significantly worse in patients with knee OA and depression ( p <0.0001), 13 neuropathic pain ( p <0.001), 29 or poor sleep quality ( p <0.001), 14 compared to those with knee OA with no depression, no neuropathic pain, or normal sleep quality.…”

“… 14 WOMAC pain subscale scores were significantly worse in patients with knee OA and depression ( p <0.0001), 13 neuropathic pain ( p <0.001), 29 or poor sleep quality ( p <0.001), 14 compared to those with knee OA with no depression, no neuropathic pain, or normal sleep quality.…”

“… 13 A further study in the same population also showed significant associations between PHQ-9 depression scores, WOMAC scores, and sleep quality. 14 Another publication reported that 30% of patients ≥40 years of age in Egypt with symptomatic/radiographic knee OA had BDI scores consistent with depression, compared with 5% of healthy controls ( p =0.03). Further, there was a significant correlation between BDI depression and WOMAC score ( p =0.005).…”

“…Of these, 20 publications reported studies from 10 countries in Africa and the Middle East (Figure 2). [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Categorizing the studies by outcomes, 7 reported on epidemiology [15][16][17]19,24,25,28 (prevalence data only) and 16 reported on humanistic burden. [12][13][14][18][19][20][21][22][23][25][26][27][28][29][30][31] No studies reported on economic burden/outcomes, and no studies were identified that reported incidence, survival/death rates, or all-cause mortality rates.…”

Measures of Sleep in Rheumatologic Diseases: Sleep Quality Patient‐Reported Outcomes in Rheumatologic Diseases

“…The PSQI is a legacy instrument that has been used to study prevalence of poor sleep and associated factors in a wide range of patients with rheumatologic diagnoses, including systemic lupus erythematosus (SLE) (30–32), RA (33–36), spondyloarthritides (37–39), systemic sclerosis (28,33), Sjögren syndrome (40,41), osteoarthritis (42–44), and fibromyalgia (45,46). It may not be able to detect well‐known disturbances of sleep that accompany aging (25).…”