0910 Sleep-pain Behaviors Predict Insomnia, Pain, and Physical Function over One Year Following Total Knee Arthroplasty in Individuals with Knee Osteoarthritis. (27th April 2018)

• Record Type: Journal Article
• Authors: Hughes, A J; Richards, J M; Campbell, C M; Haythornthwaite, J A; Edwards, R R; Smith, M T
• Is Part Of: Sleep. Volume 41(2018)Supplement 1
• Page Start: A338
• Page End: A338
• Publication Date: 2018-04-27
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsy061.909
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Cognitive behavioral theory for insomnia posits that maladaptive efforts to cope with pain, such as retiring to the bed/bedroom when in pain and taking extra pain medications to promote sleep, paradoxically contribute to persistent insomnia, a known risk factor for pain chronification. The present study evaluated sleep-pain behaviors and their concurrent and longitudinal associations with insomnia, pain, and physical function in individuals with knee osteoarthritis (KOA) undergoing total knee arthroplasty (TKA). Secondary analyses examined insomnia as a mediator between sleep-pain behaviors and functional outcomes. Methods: Participants were 109 individuals (Age: M =63.9; SD =8.8; 54% female) with KOA scheduled to undergo TKA. Measures were collected at baseline and at 6 (n=73), 13 (n=73), 26 (n=87), and 52 (n=107) weeks following TKA. Measures included: the 3-item Sleep-Pain Behaviors Survey (SPBS); the Insomnia Severity Index (ISI); actigraphy (sleep onset latency [SOL], sleep efficiency [SE%], wake after sleep onset [WASO], and total sleep time [TST]); the Brief Pain Inventory (BPI); and the Physical Function subscale from the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Analyses used linear mixed-effects regression analyses, controlling for time, concurrent depression, and concurrent levels of each outcome. Results: Beyond its concurrent association with ISI ( B =1.12, p <.001), WASO ( B =2.50, p=.02), BPI ( B =0.32, p <.001), and WOMAC ( B =3.39, p <.001), the SPBS was a longitudinal predictor of ISI ( B =0.42, p =.03), SOL ( B =3.19, p =.04), BPI ( B =0.16, p <.01), and WOMAC ( B =1.71, p <.01). ISI significantly mediated the relationship between SPBS and both pain (BPI: concurrent 95% CI [0.04, 0.11]; longitudinal: 95% CI [0.01, 0.07]) and physical function (WOMAC: concurrent 95% CI [0.52, 1.36]; longitudinal 95% CI: [.04, 0.74]). Conclusion: For individuals with KOA, behavioral interventions focused on reducing sleep-pain behaviors may offer the potential to reduce insomnia, thereby improving pain and physical function outcomes following TKR. Support (If Any): R01AG034982 (PI: RR Edwards).