Zhaoli Dai1,2, Tuhina Neogi3,4, Carrie Brown3,4, Michael Nevitt3,4, Cora E Lewis3,4, James Torner3,4, David T Felson3,4. 1. From the Boston University School of Medicine, Department of Medicine, Section of Rheumatology, Boston, Massachusetts, USA; Epidemiology and Biostatistics, University of California, San Francisco, California; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology and the Institute for Clinical and Translational Science, The University of Iowa, Iowa, USA; The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia; Centre for Epidemiology, University of Manchester and the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC), Manchester University National Health Service (NHS) Trust, Manchester, UK. zhaoli.dai-keller@sydney.edu.au. 2. Z. Dai, PhD, Boston University School of Medicine, Department of Medicine, Section of Rheumatology, and The University of Sydney, Faculty of Medicine and Health, School of Pharmacy; T. Neogi, MD, PhD, Boston University School of Medicine, Department of Medicine, Section of Rheumatology; C. Brown, MS, Boston University School of Medicine, Department of Medicine, Section of Rheumatology; M. Nevitt, PhD, Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; J. Torner, MD, The Department of Epidemiology and the Institute for Clinical and Translational Science, The University of Iowa; D.T. Felson, MD, MPH, Boston University School of Medicine, Department of Medicine, Section of Rheumatology, and Centre for Epidemiology, University of Manchester and the NIHR Manchester BRC, Manchester University NHS Trust. zhaoli.dai-keller@sydney.edu.au. 3. From the Boston University School of Medicine, Department of Medicine, Section of Rheumatology, Boston, Massachusetts, USA; Epidemiology and Biostatistics, University of California, San Francisco, California; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology and the Institute for Clinical and Translational Science, The University of Iowa, Iowa, USA; The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia; Centre for Epidemiology, University of Manchester and the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC), Manchester University National Health Service (NHS) Trust, Manchester, UK. 4. Z. Dai, PhD, Boston University School of Medicine, Department of Medicine, Section of Rheumatology, and The University of Sydney, Faculty of Medicine and Health, School of Pharmacy; T. Neogi, MD, PhD, Boston University School of Medicine, Department of Medicine, Section of Rheumatology; C. Brown, MS, Boston University School of Medicine, Department of Medicine, Section of Rheumatology; M. Nevitt, PhD, Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; J. Torner, MD, The Department of Epidemiology and the Institute for Clinical and Translational Science, The University of Iowa; D.T. Felson, MD, MPH, Boston University School of Medicine, Department of Medicine, Section of Rheumatology, and Centre for Epidemiology, University of Manchester and the NIHR Manchester BRC, Manchester University NHS Trust.
Abstract
OBJECTIVE: We examined the association between sleep and odds of developing knee pain, and whether this relationship varied by status of widespread pain (WSP). METHODS: At the 60-month visit of the Multicenter Osteoarthritis Study, sleep quality and restless sleep were each assessed by using a single item from 2 validated questionnaires. Each sleep measure was categorized into 3 levels, with poor/most restless sleep as the reference. WSP was defined as pain above and below the waist on both sides of the body and axially using a standard homunculus, based on the American College of Rheumatology criteria. Outcomes from 60-84 months included (1) knee pain worsening (KPW; defined as minimal clinically important difference in WOMAC pain), (2) prevalent, and (3) incident consistent frequent knee pain. We applied generalized estimating equations in multivariable logistic regression models. RESULTS: We studied 2329 participants (4658 knees; 67.9 yrs, body mass index 30.9]. We found that WSP modified the relationship between sleep quality and KPW (p = 0.002 for interaction). Among persons with WSP, OR (95% CI) for KPW was 0.53 (0.35-0.78) for those with very good sleep quality (p trend < 0.001); additionally, we found the strongest association of sleep quality in persons with > 8 painful joint sites (p trend < 0.01), but not in those with ≤ 2 painful joint sites. Similar results were observed using restless sleep, in the presence of WSP. The cross-sectional relationship between sleep and prevalence of consistent frequent knee pain was significant. CONCLUSION: Better sleep was related to less KPW with coexisting widespread pain.
OBJECTIVE: We examined the association between sleep and odds of developing knee pain, and whether this relationship varied by status of widespread pain (WSP). METHODS: At the 60-month visit of the Multicenter Osteoarthritis Study, sleep quality and restless sleep were each assessed by using a single item from 2 validated questionnaires. Each sleep measure was categorized into 3 levels, with poor/most restless sleep as the reference. WSP was defined as pain above and below the waist on both sides of the body and axially using a standard homunculus, based on the American College of Rheumatology criteria. Outcomes from 60-84 months included (1) knee pain worsening (KPW; defined as minimal clinically important difference in WOMAC pain), (2) prevalent, and (3) incident consistent frequent knee pain. We applied generalized estimating equations in multivariable logistic regression models. RESULTS: We studied 2329 participants (4658 knees; 67.9 yrs, body mass index 30.9]. We found that WSP modified the relationship between sleep quality and KPW (p = 0.002 for interaction). Among persons with WSP, OR (95% CI) for KPW was 0.53 (0.35-0.78) for those with very good sleep quality (p trend < 0.001); additionally, we found the strongest association of sleep quality in persons with > 8 painful joint sites (p trend < 0.01), but not in those with ≤ 2 painful joint sites. Similar results were observed using restless sleep, in the presence of WSP. The cross-sectional relationship between sleep and prevalence of consistent frequent knee pain was significant. CONCLUSION: Better sleep was related to less KPW with coexisting widespread pain.
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