Common Sleep Habits of Older Community-Living People with Osteoarthritis

PURPOSE: Patients with osteoarthritis (OA) report fatigue to be one of their most significant concerns. Despite the association between sleep disruption and fatigue, there has been little exploration of the sleep habits of persons with OA in their home environment. The current study addressed this gap.
METHODS: From Sept 2005-March 2006, a phone survey was administered to an established, population-based cohort of individuals with OA. Subjects were recruited from two counties in Ontario, Canada and were aged 55+ years with moderate to severe hip or knee OA at baseline (1995-1997). The interview asked questions about sleep onset, sleep maintenance, daytime alertness, and circadian factors to provide a comprehensive screen of sleep habits that might suggest sleep disorders amenable to intervention to reduce fatigue in this population. Subjects also provided sociodemographic information; arthritis pain severity (McGill Pain Intensity score), fatigue (Profile of Mood States [POMS] - fatigue scale) and mood (CES-D scores) were assessed to evaluate the relationship between sleep characteristics and other common concerns. Descriptive statistics were performed; T-tests were used to compare responses for those with and without symptoms of restless legs syndrome; and Chi-square tests were obtained for categorical data.
RESULTS: The average age of the 753 subjects was 76.5 (SD 7.2) years and 75.8% were women. Over one-quarter (26.7%) of subjects reported taking longer than 30 minutes to fall asleep on average, 42.8% endorsed symptoms suggestive of restless legs syndrome, 28.5% thought that they snored often or always, and 47.4% never or rarely felt refreshed on awakening. Only 6.9% had been diagnosed with a sleep disorder, and only 3.9% of the study group reported they had received treatment for a sleep disorder from a health care provider. Women were less likely than men to have received a sleep disorder diagnosis or to have received treatment (p<0.05), despite reporting more sleep complaints. Those who had symptoms suggestive of restless legs syndrome (a nocturnal restless or uncomfortable sensation relieved by movement often or always) had higher CES-D scores (10.8 vs. 8.4, p<0.001) indicating more depressed mood, greater McGill pain intensity scores (65.5 vs. 56.3, p<0.001), and higher POMS-fatigue scores (12.2 vs. 8.8, p<0.001) indicating greater fatigue, than those who did not.
CONCLUSIONS: Patients with OA report many behaviors characteristic of common, treatable sleep disorders. However, few patients with OA have had sleep disorders identified by physicians, and even fewer have received treatment. Women appear to be even less likely to receive a diagnosis and treatment. Restless legs syndrome may be more common in the OA population than previously recognized, and is associated with other OA clinical comorbidities.

 B.J. Murray, None; C. Cheung, None; M.R. French, None; L. Gagliese, None; A.M. Davis, None; G.A. Hawker, None.