Four in ten people with osteoarthritis may have insomnia

Design

Prevalence systematic review and meta-analysis of 18 observational studies

Population

202,847 people with knee, hip or hand osteoarthritis

Primary outcome

Prevalence of insomnia, sleep apnoea, restless legs and narcolepsy

Effect

Insomnia 42% (34–51%); sleep apnoea 37% (6–67%); restless legs 35% (10–61%)

A systematic review pooled 18 observational studies (202,847 participants) reporting sleep disorders in people with knee, hip or hand osteoarthritis.

Insomnia was the most common, at 42% (95% CI 34% to 51%). Sleep apnoea was estimated at 37% and restless legs syndrome at 35%, but both with very wide intervals (6% to 67% and 10% to 61%). No study reported narcolepsy. Certainty of evidence was very low, with large differences between studies in how sleep disorders were diagnosed.

The pooled numbers are imprecise, but the direction is clear enough to act on: disturbed sleep is common in osteoarthritis, and poor sleep worsens pain perception and function.

In clinic, a single question about sleep can uncover a treatable contributor to pain, and some patients being worked up for arthroplasty may have undiagnosed sleep apnoea relevant to anaesthesia.

• Ask people with osteoarthritis how they are sleeping.
• Consider sleep apnoea screening in those with obesity, snoring or daytime sleepiness, especially before arthroplasty.
• Treat insomnia as a contributor to pain, not only a consequence of it.
• Refer for cognitive behavioural therapy for insomnia where available.

Why it matters

Unaddressed sleep disorders may explain pain and function that do not match the radiograph.

Don't overread it

Very low certainty; the true prevalence of sleep apnoea and restless legs could be far lower or higher.

The statistics, in plain English

An interval from 6% to 67% for sleep apnoea means the studies disagreed so much that the pooled figure is close to a guess. The insomnia estimate is narrower and more trustworthy. Most studies were cross-sectional, so they show co-occurrence, not that osteoarthritis causes poor sleep.

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