Sleep Quality and Fatigue Are Associated with Pain Exacerbations of Hip Osteoarthritis: An Internet-based Case-crossover Study

Abstract

Objective.To evaluate the association of sleep quality, sleep duration, and fatigue with hip pain exacerbations in persons with symptomatic hip osteoarthritis (OA).Methods.Participants (n = 252) 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 2 points in pain intensity compared with baseline on a numeric rating scale (0–10). Subjective sleep quality and sleep duration were assessed using the Pittsburgh Sleep Quality Index, and fatigue was measured by Multidimensional Assessment of Fatigue in both periods. Univariable and multivariable conditional logistic regressions were used to assess the association.Results.Of the 252 participants, 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 (OR 1.72, 95% CI 1.04–2.86; OR 1.92, 95% CI 1.21–3.05, respectively). Short sleep duration was not associated with pain exacerbations. Poor sleep quality and greater fatigue remained associated with pain exacerbations after adjustment 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.

Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis

“…The interrelations between sleep and pain have been well characterized over the past two decades, with epidemiological, experimental, and clinical research providing broad support for a bidirectional relationship [98]. Consistent with these findings, a number of studies have linked sleep problems with increased pain and pain sensitivity among individuals with OA [108,109,110,111,112], which suggests that sleep could be an important treatment target for reducing OA pain—although clinical trials have not always supported that premise [113].…”

Is Heel Height Associated with Pain Exacerbations in Hip Osteoarthritis Patients?—Results from a Case-Crossover Study

“…High heel wearing could result in compensatory changes, such as increased lower limb muscle activity [ 28 ], which contributes to the higher energy cost when walking in high heels. Our previous study showed that fatigue was associated with pain exacerbations in persons with symptomatic hip OA [ 17 ], and this implies a potential indirect association between physical activity level with pain exacerbations through fatigue. What should be noted is that most people, especially women who wear high heels on a regular basis, spend the majority of time sitting rather than walking, which might contribute to a lower physical activity level [ 36 ].…”

“…An Internet-based, case-crossover study was designed to assess the relation of wearing shoes with different heel heights, and the duration of wearing such shoes to the risk of hip pain exacerbation in Australia from May 2015 to June 2017. This design has previously been described in hip and knee OA pain exacerbation studies [ 12 , 13 , 14 , 15 , 16 , 17 ]. Briefly, the case-crossover design uses each participant as their own control to assess the effects of transient exposures (risk factors) on episodic events (e.g., pain exacerbation) during a certain follow-up period (e.g., 90 days).…”

Self‐Report Measures of Physical Activity

“…Although the IPAQ questionnaire has been used in several RCTs, it was predominately designed for observational or population‐based studies. Several observational studies in MSK populations have used the IPAQ‐LF and the IPAQ‐SF .…”