How Does Sleep Quality Affect Pain and Fatigue in Older Adults With Osteoarthritis?

elderly woman can't sleep
elderly woman can’t sleep
Poor sleep quality was linked to increased pain and fatigue in older adults with symptomatic osteoarthritis.

According to study results published in the Journal of Pain, poor sleep quality is associated with increased pain and fatigue in older patients with symptomatic osteoarthritis (OA).

Researchers conducted this microlongitudinal study to assess how sleep quality affects pain and fatigue related to OA during the following day. A total of 160 patients with hip and/or knee OA (median age, 71 years) and mild to moderate pain and fatigue completed daily diaries for 5 days, recording symptom intensity (numerical rating scale, range 0-10) on waking and at 11 am, 3 pm, 7 pm, and bedtime.

Participants also self-reported their sleep quality for each night and wore actigraphs on their wrists to monitor sleep duration and efficiency, onset latency, and time awake after sleep onset.

Average sleep quality was reported to be fair, and actigraph results revealed that most experienced good sleep, with a median duration of 7.35 hours, efficiency of 83.8%, latency of 16 minutes, and time awake after onset of 42 minutes.

Overall symptom intensity was found to follow a diurnal pattern, with only slight variations throughout the day in pain (mean at bedtime, 3.39; at awakening, 3.05) and fatigue (mean at bedtime, 4.97; at awakening, 3.27). Considered individually, participants demonstrated greater variation.

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Via multilevel linear regression models and analysis of time interaction effects, the researchers discovered that poor sleep quality was significantly associated with worse pain and fatigue in the morning (X2, 27.2 and 153.9, respectively; both P <.001). There were, however, no significant associations between time of symptom measurement and actigraph-based sleep parameters.

Limitations to this study include residual confounding, a lack of screening for sleep disorders, and an inability to generalize to a wider population.

“Our findings suggest potentially important implications for future studies of time-based interventions,” said the researchers. “[P]eople living with OA may be counseled about the likely outcome of a poor night’s sleep on their symptoms, and this information may be used to inform the optimal timing of pharmacological and/or non-pharmacological interventions to reduce pain and fatigue.”

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Whibley D, Braley TJ, et al. Transient effects of sleep on next-day pain and fatigue in older adults with symptomatic osteoarthritis [published on April May 11, 2019]. J Pain. doi:10.1016/j.jpain.2019.04.011