Abstract
BackgroundFew studies have examined patterns of specific sleep problems among individuals with osteoarthritis (OA). The primary objective of this study was to examine prevalence of symptoms of insomnia and obstructive sleep apnea (OSA) among Veterans with OA. Secondary objectives were to assess proportions of individuals with insomnia and OSA symptoms who may have been undiagnosed and to examine Veterans’ characteristics associated with insomnia and OSA symptoms.MethodsVeterans (n = 300) enrolled in a clinical trial completed the Insomnia Severity Index (ISI) and the Berlin Questionnaire (BQ) at baseline; proportions of participants with symptoms consistent with insomnia and OSA were calculated, using standard cut-offs for ISI and BQ. For Veterans with insomnia and OSA symptoms, electronic medical records were searched to identify whether there was a diagnosis code for these conditions. Multivariable linear (ISI) and logistic (BQ) regression models examined associations of the following characteristics with symptoms of insomnia and OSA: age, gender, race, self-reported general health, body mass index (BMI), diagnosis of post-traumatic stress disorder (PTSD), pain severity, depressive symptoms, number of joints with arthritis symptoms and opioid use.ResultsSymptoms consistent with insomnia and OSA were found in 53 and 66% of this sample, respectively. Among participants screening positive for insomnia and OSA, diagnosis codes for these disorders were present in the electronic medical record for 22 and 51%, respectively. Characteristics associated with insomnia were lower age (β (SE) = − 0.09 (0.04), 95% confidence interval [CI] = − 0.16, − 0.02), having a PTSD diagnosis (β (SE) = 1.68 (0.73), CI = 0.25, 3.11), greater pain severity (β (SE) = 0.36 (0.09), CI = 0.17, 0.55), and greater depressive symptoms (β (SE) = 0.84 (0.07), CI = 0.70, 0.98). Characteristics associated with OSA were higher BMI (odds ratio [OR] = 1.13, CI = 1.06, 1.21), greater depressive symptoms (OR = 1.12, CI = 1.05, 1.20), and opioid use (OR = 0.51, CI = 0.26, 0.99).ConclusionsInsomnia and OSA symptoms were very common in Veterans with OA, and a substantial proportion of individuals with symptoms may have been undiagnosed. Characteristics associated with insomnia and OSA symptoms were consistent with prior studies.Trial registrationNCT01130740.
Highlights
Few studies have examined patterns of specific sleep problems among individuals with osteoarthritis (OA)
Seventy-six percent of participants (n = 228/300) screened positive for at least one sleep disturbance, including 23% screening “high risk” for sleep apnea alone (n = 70), and 10% screening positive for insomnia alone (n = 30)
Self-reported symptoms consistent with insomnia and obstructive sleep apnea (OSA) were highly prevalent in this cohort, with a high degree of overlap between those screening positive for Bivariate and Multivariable Linear Regression Models of Insomnia (ISI) Scores
Summary
Few studies have examined patterns of specific sleep problems among individuals with osteoarthritis (OA). The primary objective of this study was to examine prevalence of symptoms of insomnia and obstructive sleep apnea (OSA) among Veterans with OA. There is increasing recognition that sleep disturbance is a common comorbidity among individuals with osteoarthritis (OA) [1,2,3,4]. Common sleep disturbances include insomnia and obstructive sleep apnea (OSA). Among patients with OA, sleep problems are associated with greater pain severity [4] This relationship is likely a reciprocal one; in some studies sleep disturbance has predicted subsequent increases in pain severity, and in others, pain has predicted subsequent sleep disturbance [10]
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