Racial/ethnic differences in sleep quality among older adults with osteoarthritis

Published:April 22, 2017DOI:



      To examine racial/ethnic differences in sleep quality and the pain-sleep association among older adults with osteoarthritis of the knee.


      Baseline interview followed by a 7-day microlongitudinal study using accelerometry and self-reports.


      Participants were community residents in western Alabama and Long Island, NY.


      Ninety-six African Americans (AAs) and 128 non-Hispanic whites (NHWs) with physician-diagnosed knee osteoarthritis, recruited from a variety of clinical and community settings.


      Self-reports yielded demographics, body mass index, physical health problems, and depressive symptoms. Sleep quality was measured for 3 to 7 nights using wrist-worn accelerometers; pain was self-reported daily over the same period.


      With demographics and health controlled, AAs displayed poorer sleep efficiency, greater time awake after sleep onset and sleep fragmentation, and marginally more awakenings during the night, but no differences in total sleep time. AAs also showed greater night-to-night variability in number of awakenings and sleep fragmentation, and marginally greater variability in total sleep time and sleep efficiency. Sleep quality was not associated with pain either the day before sleep or the day after. Average daily pain interacted with race, whereas AAs displayed no effect of pain on sleep efficiency, NHWs exhibited better sleep efficiency at higher levels of average pain.


      These data corroborate previous studies documenting poorer sleep among AAs vs NHWs. The findings of greater night-to-night variability in sleep among AAs, as well as a negative association of pain with sleep quality among NHWs, are unique. Further study is needed to elucidate these findings.


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        • Crowley K.
        Sleep and sleep disorders in older adults.
        Neuropsychol Rev. 2011; 21: 41-53
        • Ancoli-Israel S.
        Sleep and its disorders in aging populations.
        Sleep Med. 2009; 10: S7-11
        • Felson D.T.
        • Zhang Y.
        An update on the epidemiology of knee and hip osteoarthritis with a view to prevention.
        Arthritis Rheum. 1998; 41: 1343-1355
        • Burns R.
        • Graney M.J.
        • Lummus A.C.
        • Nichols L.O.
        • Martindale-Adams J.
        Differences of self-reported osteoarthritis disability and race.
        J Natl Med Assoc. 2007; 99: 1046-1051
        • Allen K.D.
        • Renner J.B.
        • Devellis B.
        • Helmick C.G.
        • Jordan J.M.
        Osteoarthritis and sleep: the Johnston County Osteoarthritis Project.
        J Rheumatol. 2008; 35 ([doi:08/13/0525 pii]): 1102-1107
        • Parmelee P.A.
        • Tighe C.A.
        • Dautovich N.D.
        Sleep disturbance in osteoarthritis: linkages with pain, disability, and depressive symptoms.
        Arthritis Care Res. 2015; 67: 358-365
        • Smith M.T.
        • Quartana P.J.
        • Okonkwo R.M.
        • Nasir A.
        Mechanisms by which sleep disturbance contributes to osteoarthritis pain: a conceptual model.
        Curr Pain Headache Rep. 2009; 13: 447-454
        • Cruz-Almeida Y.
        • Sibille K.T.
        • Goodin B.R.
        • et al.
        Racial and ethnic differences in older adults with knee osteoarthritis.
        Arthritis Rheumatol. 2014; 66: 1800-1810
        • Smith D.M.
        • Parmelee P.A.
        Within-day variability of fatigue and pain among African Americans and non-Hispanic whites with osteoarthritis of the knee.
        Arthritis Care Res. 2016; 68: 115-122
        • Beatty D.L.
        • Hall M.H.
        • Kamarck T.A.
        • et al.
        Unfair treatment is associated with poor sleep in African American and Caucasian adults: Pittsburgh SleepSCORE Project.
        Health Psychol. 2012; 30: 351-359
        • Carnethon M.R.
        • De Chavez P.J.
        • Zee P.C.
        • et al.
        Disparities in sleep characteristics by race/ethnicity in a population-based sample: Chicago Area Sleep Study.
        Sleep Med. 2016; 18: 50-55
        • Cunningham T.J.
        • Ford E.S.
        • Chapman D.P.
        • Liu Y.
        • Croft J.B.
        Independent and joint associations of race/ethnicity and educational attainment with sleep-related symptoms in a population-based US sample.
        Prev Med (Baltim). 2015; 77: 99-105
        • Hale L.
        • Do D.P.
        Racial differences in self-reports of sleep duration in a population-based study.
        Sleep. 2007; 30: 1096-1103
        • Song Y.
        • Ancoli-Israel S.
        • Lewis C.E.
        • Redline S.
        • Harrison S.L.
        • Stone K.L.
        The association of race/ethnicity with objectively measured sleep characteristics in older men.
        Behav Sleep Med. 2012; 10: 54-69
        • Tomfohr L.
        • Pung M.A.
        • Edwards Kate M.
        • Dimsdale J.E.
        Racial differences in sleep architecture: the role of ethnic discrimination.
        Biol Psychol. 2012; 89: 34-38
        • Thomas K.S.
        • Bardwell W.A.
        • Ancoli-Israel S.
        • Dimsdale J.E.
        The toll of ethnic discrimination on sleep architecture and fatigue.
        Health Psychol. 2006; 25: 635-642
        • Chen X.
        • Wang R.
        • Lee P.
        • Lutsey P.L.
        • Javaheri S.
        • Alcántara C.
        • Jackson C.
        • Williams M.A.
        • Redline S.
        Racial/ethnic differences in sleep disturbances: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Sleep. 2015; 38: 877-888
        • Wilson K.G.
        • Watson S.T.
        • Currie S.R.
        Daily diary and ambulatory activity monitoring of sleep in patients with insomnia associated with chronic musculoskeletal pain.
        Pain. 1998; 75: 75-84
        • Tang N.K.Y.
        • Goodchild C.E.
        • Sanborn A.N.
        • Howard J.
        • Salkovskis P.M.
        Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: a multilevel daily process study.
        Sleep. 2012; 35: 675-687A
        • Lunde L.
        • Krangnes L.
        Characteristics of sleep in older persons with chronic pain: a study based on actigraphy and self-reports.
        Clin J Pain. 2010; 26: 132-137
        • Canivet C.
        • Ostergren P.-O.
        • Choi B.
        • et al.
        Sleeping problems as a risk factor for subsequent musculoskeletal pain and the role of job strain: results from a one-year follow-up of the Malmö Shoulder Neck Study Cohort.
        Int J Behav Med. 2008; 15: 254-262
        • Aili K.
        • Nyman T.
        • Svartengren M.
        • Hillert L.
        Sleep as a predictive factor for the onset and resolution of multi-site pain: a 5-year prospective study.
        Eur J Pain. 2015; 19: 341-349
        • Anderson R.J.
        • McCrae C.S.
        • Staud R.
        • Berry R.B.
        • Robinson M.E.
        Predictors of clinical pain in fibromyalgia: examining the role of sleep.
        J Pain. 2012; 13: 350-358
        • Alsaadi S.M.
        • McAuley J.H.
        • Hush J.M.
        • et al.
        The bidirectional relationship between pain intensity and sleep disturbance/quality in patients with low back pain.
        Clin J Pain. 2014; 30: 755-765
        • Edwards R.R.
        • Almeida D.M.
        • Klick B.
        • Haythornthwaite J.A.
        • Smith M.T.
        Duration of sleep contributes to next-day pain report in the general population.
        Pain. 2008; 137: 202-207
        • Finan P.H.
        • Goodin B.R.
        • Smith M.T.
        The association of sleep and pain: an update and a path forward.
        J Pain. 2013; 14: 1539-1552
        • Quartana P.J.
        • Wickwire E.M.
        • Klick B.
        • Grace E.
        • Smith M.T.
        Naturalistic changes in insomnia symptoms and pain in temporomandibular joint disorder: a cross-lagged panel analysis.
        Pain. 2010; 149: 325-331
        • Dzierzewski J.M.
        • Williams J.M.
        • Roditi D.
        • et al.
        Daily variations in objective nighttime sleep and subjective morning pain in older adults with insomnia: evidence of covariation over time.
        J Am Geriatr Soc. 2010; 58: 925-930
        • Wilcox S.
        • Brenes G.A.
        • Levine D.
        • et al.
        Factors related to sleep disturbance in older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis.
        J Am Geriatr Soc. 2000; 48: 1241-1251
        • Pfeiffer E.
        A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.
        J Am Geriatr Soc. 1975; 23: 433-441
        • Radloff L.S.
        The CES-D scale: a self-report depression scale for research in the general population.
        Appl Psychol Measur. 1977; 1: 385-401
        • Cole R.J.
        • Kripke D.F.
        • Gruen W.
        • Mullaney D.J.
        • Gillin J.C.
        Automatic wake/sleep identification from wrist activity.
        Sleep. 1992; 15: 461-469
        • Dillon H.R.
        • Lichstein K.L.
        • Dautovich N.D.
        • Taylor D.J.
        • Riedel B.W.
        • Bush A.J.
        Variability in self-reported normal sleep across the adult age span.
        J Gerontol B Psychol Sci Soc Sci. 2015; 70: 46-56
        • Knutson K.L.
        • Rathouz P.J.
        • Yan L.L.
        • Liu K.
        • Lauderdale D.S.
        Intra-individual daily and yearly variability in actigraphically recorded sleep measures: the CARDIA study.
        Sleep. 2007; 30: 793-796
        • Silva A.
        • Araujo P.
        • Zager A.
        • Tufik S.
        • Andersen M.L.
        Sex differences in sleep pattern of rats in an experimental model of osteoarthritis.
        Eur J Pain. 2011; 15: 545-553
        • Pittsley M.
        • Gehrman P.
        • Cohen-Zion M.
        • Stepnowsky C.
        • Marler M.
        • Ancoli-Israel S.
        Comparing night-to-night variability of sleep measures in elderly African Americans and whites.
        Behav Sleep Med. 2005; 3: 63-72
        • White L.H.
        • Lyons O.D.
        • Yadollahi A.
        • Ryan C.M.
        • Bradley D.T.
        Night-to-night variability in obstructive sleep apnea severity: relationship to overnight rostral fluid shift.
        J Clin Sleep Med. 2015; 11: 149-156
        • Kay D.B.
        • Dzierzewski J.M.
        • Rowe M.
        • McCrae C.S.
        Greater night-to-night variability in sleep discrepancy among older adults with a sleep complaint compared to noncomplaining older adults.
        Behav Sleep Med. 2013; 11: 76-90
        • Suh S.
        • Nowakowski S.
        • Bernert R.A.
        • et al.
        Clinical significance of night-to-night sleep variability in insomnia.
        Sleep Med. 2012; 13: 469-475
        • Hamilton N.A.
        • Affleck G.
        • Tennen H.
        • et al.
        Fibromyalgia: the role of sleep in affect and in negative event reactivity and recovery.
        Health Psychol. 2008; 27: 490-497