Background Studies report that sleep disturbances are often associated with chronic musculoskeletal disease. There is no agreed definition of sleep health, but some characteristics, such as sleep duration (number of hours daily) and sleep quality or satisfaction (subjective evaluation of good or poor sleep) are used to evaluate sleep health. In a previous study in patients with severe osteoarthritis awaiting total knee replacement (TKR), patients reporting good quality sleep had better health-related quality of life (HRQL) measured by the specific WOMAC and generic SF-36 questionnaires.
Objectives To measure sleep health in patients included on a waiting list for TKR and 12 months after TKR.
Methods Prospective study with a 12-month follow up. Sociodemographic and clinical variables were determined. Sleep health: hours of sleep and reparative sleep (RS) were examined using the question “How well do you usually sleep?” measured on a Likert scale (1=good [RS], 2=regular, 3=badly, 4=with medication/treatment (non-reparative sleep [NRS]). Function and pain were measured using the WOMAC and SF-36 questionnaires. Comparisons were made using t-tests (paired samples) and McNemar's test. Linear regression models were used to analyze associations. Dependent variables: WOMAC and SF-36 pain and function dimensions; independent variables: sleep quality, age, sex, BMI, number of comorbidities, depression/anxiety.
Results 105 patients (79% female, mean age 69.39 years [SD 8.3]) were included. 80% had ≥2 comorbidities (mean 2.71 [SD 1.8]), mean BMI was 33.68 (SD 6.7), 32 had depression/anxiety, and mean sleep duration was 6.63 hours (SD 1.4). 12 months after TKF there were significant improvements in WOMAC dimension scores (mean >25 points, p<0.001) and SF-36 scores (mean >19). At study inclusion, 23% reported RS with a mean sleep duration of 7.5 hours (SD 1.1) vs. 6.24 hours (SD 1.5) in NRS patients (p=0.002). 12 months after TKR, 40% of patients had RS (p=0.029). Patients with RS had better scores in all quality of life dimensions (<10 points) than those with NRS (p<0.05) at baseline and at 12 months. Multivariate analysis showed RS was independently associated with pain and function (WOMAC and SF-36) (p<0.007).
Conclusions Sleep health was associated with better HRQL before and after TKR. Although more patients had RS after TKR, 60% of patients continued not to have sleep health. Although often undervalued clinically, sleep health is closely associated with the health status.
Acknowledgements This work was funded by project PI/13/00948, integrated in the Plan Nacional I+D+I and cofounded by ISCIII-Subdirecciόn General de Evaluaciόn and European Regional Development Fund (ERDF).
Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014 Jan 1;37(1):9–17. doi: 10.5665/sleep.3298.
Disclosure of Interest None declared