title: The multidimensionality of sleep quality and its relationship to fatigue in older adults with painful osteoarthritis.
abstract: OBJECTIVE
  To evaluate subjective sleep quality and its relationship to fatigue in older adults with osteoarthritis (OA).
  
  
  METHODS
  In a community cohort with hip/knee OA, subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and fatigue was measured by the Profile of Mood States - Fatigue subscale (POMS-F). Correlates of sleep quality and fatigue were determined by standardized interviews including socio-demographics, OA severity (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) summary score), comorbidity, depression (Center for Epidemiologic Studies Depression Scale, CES-D), stressful life events, daytime napping, symptoms of restless legs syndrome (RLS) and prior sleep disorder diagnoses. Logistic regression examined correlates of poor sleep (PSQI score>5). Linear regression evaluated the relationship between poor sleep and fatigue, and the effect of napping on this relationship.
  
  
  RESULTS
  In 613 respondents, mean age was 78 years, 78% were female, 11% had concomitant fibromyalgia, and 26% had 3+ comorbid conditions. Responses indicated moderate OA severity. Seventy percent reported poor sleep; 25% met criteria for RLS and 6.5% reported a diagnosed sleep disorder. Independent correlates of poor sleep were: greater arthritis severity (adjusted odds ratio (OR) per unit increase in WOMAC score=1.03, P<0.0001), 3+ comorbid conditions (adjusted OR=1.88; P=0.03), depressed mood (adjusted OR per unit increase in CES-D score=1.09, P<0.0001), and RLS (adjusted OR=1.87; P=0.02). Controlling for previously reported fatigue correlates, poor sleep was significantly associated with greater fatigue (parameter estimate=1.63, P=0.0003) and napping did not moderate this relationship (P=0.55 for the interaction between napping and poor sleep).
  
  
  CONCLUSIONS
  Among older people with OA, poor sleep is highly prevalent and significantly linked with fatigue. Identifying the nature of sleep disturbances in OA is important as treatment of sleep disturbances may reduce OA-related fatigue.
authors: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada. gillian.hawker@wchospital.ca
authors: G A
authors: GA
authors: Hawker
authors: M R
authors: MR
authors: French
authors: E J
authors: EJ
authors: Waugh
authors: M A M
authors: MA
authors: Gignac
authors: C
authors: C
authors: Cheung
authors: B J
authors: BJ
authors: Murray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015207:Osteoarthritis, Hip / Q000150:complications*; D020370:Osteoarthritis, Knee / Q000150:complications*; D010146:Pain / Q000150:complications; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology