Pain-induced sleep disturbances fully mediate the association between symptomatic hip and knee osteoarthritis and poor sleep quality : a cross-sectional study

Bone Jt Open. 2026 Mar 12;7(3):348-356. doi: 10.1302/2633-1462.73.BJO-2025-0325.R1.

ABSTRACT

AIMS: We assessed whether symptomatic end-stage hip and knee osteoarthritis (OA) are associated with poorer sleep quality and to what extent pain mediates these associations.

METHODS: We included symptomatic end-stage hip- and knee OA participants from the Longitudinal Leiden Orthopaedics Outcomes of Osteo-arthritis Study (LOAS) and participants without OA from the Netherlands Epidemiology of Obesity (NEO) study. We assessed sleep with the Pittsburgh Sleep Quality Index (PSQI) and performed linear regression analyses to investigate the associations between OA and sleep and the potential mediating effects of pain-related sleep disturbances.

RESULTS: Overall, 54% of the 922 hip OA and 48% of the 870 knee OA patients reported poor sleep (total PSQI > 5), compared with 21% of the 1,165 participants without OA. Both hip and knee OA were associated with worse subjective sleep quality (adjusted difference: 0.37 points (95% CI 0.29 to 0.44) and 0.23 points (95% CI 0.15 to 0.32), respectively) and pain-related sleep disturbances (adjusted difference: 1.75 points (95% CI 1.64 to 1.86) and 1.50 points (95% CI 1.38 to 1.62), respectively). The association of hip and knee OA and worse subjective sleep quality was fully mediated by pain-related sleep disturbances (112% (95% CI 90 to 145) and 123% (95% CI 90 to 191), respectively).

CONCLUSION: Symptomatic end-stage hip and knee OA are strongly associated with worse sleep quality, which is fully mediated by pain-related sleep disturbances. While the cross-sectional design limits causal inferences, these findings underscore the importance of improving both sleep quality and pain management strategies in symptomatic end-stage OA patients. Addressing sleep disturbances, which are often overlooked in clinical practice, could significantly enhance overall health and quality of life of patients with end-stage hip- or knee OA.

PMID:41812683 | DOI:10.1302/2633-1462.73.BJO-2025-0325.R1