Disrupted sleep is associated with altered pain processing by sex and ethnicity in knee osteoarthritis.
Studies indicate that improving sleep decreases reported pain in patients with knee osteoarthritis, but it is unclear if this association extends to experimentally induced pain responses. A community-based sample of 88 African American and 52 non-Hispanic white adults (45-76 years) with knee osteoarthritis completed the Insomnia Severity Index and the arousal subscale of the Sleep Hygiene and Practices Scale. Participants underwent quantitative sensory testing, including measures of pain sensitivity and facilitation at the knee, and pain inhibition. Outcomes were analyzed with multiple Tobit hierarchical regression models, with adjustment for relevant covariates. Ethnicity and sex by sleep interactions were also entered into the models. After covariate adjustment, main associations were not observed. However, sex interacted with insomnia severity to predict greater temporal summation of heat and punctate pressure pain among women and lower heat temporal summation among men. Men and women who engaged in frequent arousal-associated sleep behaviors demonstrated higher and lower heat temporal summation, respectively. Non-Hispanic whites with greater insomnia severity displayed lower pressure pain thresholds and pain inhibition. Our findings are the first to demonstrate that disrupted sleep is associated with altered pain processing differentially by sex and ethnicity/race among people with knee osteoarthritis.


CONCLUSIONS
This article presents the association between insomnia severity, maladaptive sleep behaviors, and experimentally induced pain responses among people with knee osteoarthritis. Disrupted sleep was associated with altered pain processing by sex and ethnicity/race. Offering sleep interventions may help ameliorate pain, but treatment may need to be tailored by sex and ethnicity/race.
College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona. Electronic address: megan.petrov@asu.edu.
Megan E
ME
Petrov
Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
Burel R
BR
Goodin
Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida.
Yenisel
Y
Cruz-Almeida
Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida.
Chris
C
King
College of Nursing, University of Florida, Gainesville, Florida.
Toni L
TL
Glover
Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
Hailey W
HW
Bulls
Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
Matthew
M
Herbert
Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida.
Kimberly T
KT
Sibille
Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida.
Emily J
EJ
Bartley
Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama.
Barri J
BJ
Fessler
Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama.
Adriana
A
Sotolongo
Division of Rheumatology and Clinical Immunology, College of Medicine, University of Florida, Gainesville, Florida.
Roland
R
Staud
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
David
D
Redden
Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida.
Roger B
RB
Fillingim
Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama.
Laurence A
LA
Bradley
D001741:Black or African American / Q000208:ethnology*; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000503:physiopathology*; D058748:Pain Perception / Q000502:physiology*; D017288:Pain Threshold / Q000502:physiology*; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000503:physiopathology*; D044465:White People / Q000208:ethnology*
Quantitative sensory testing; ethnicity; insomnia; knee osteoarthritis; sleep