Sleep Quality and Fatigue are Associated with Hip Osteoarthritis Pain Exacerbations: An Internet-Based Case-Crossover Study
2019
Objective To evaluate the association of sleep quality, sleep duration and fatigue with hip pain exacerbations in persons with symptomatic hip osteoarthritis (OA). Methods Eligible participants were followed for 90 days and asked to complete online questionnaires at 10-day intervals (control periods). A hip pain exacerbation (case periods) was defined as an increase of two points in pain intensity compared with baseline on the numeric rating scale (0-10). Subjective sleep quality and sleep duration were assessed using the Pittsburgh Sleep Quality Index (PSQI), and fatigue was measured by Multi-Dimensional Assessment of Fatigue (MAF) in both periods. Univariable and multivariable conditional logistic regression were used to assess the association. Results Of the 252 participants recruited, 130 (52%) were included in the final analysis. Univariate association analysis showed that both poor sleep quality and greater fatigue were associated with increased odds of pain exacerbations (odds ratio [OR] 1.72, 95% CI 1.04 to 2.86; OR 1.92, 95% CI 1.21 to 3.05 ). Short sleep duration was not associated with pain exacerbations. Poor sleep quality and greater fatigue remained associated with pain exacerbations after adjusting for physical activity and night pain levels in multivariable analysis. There was no significant interaction between sleep quality and fatigue (p=0.21). Conclusion Poor sleep quality and greater fatigue were related to pain exacerbation in persons with symptomatic hip OA. Sleep disorders and fatigue should be considered when dealing with pain exacerbations and more research is necessary to refine and further elaborate on this novel finding.
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