Sleep interventions may prevent incident knee pain on a global and independent level

According to data published in Arthritis Care & Research, patients with knee osteoarthritis who have sleep disruptions are more likely to have catastrophizing and exacerbated knee pain.

Wang and colleagues analyzed data from the Osteoarthritis Initiative (OAI) cohort, which included patients aged 45 to 79 years with knee OA or who were at an increased risk for developing OA, to examine the relationships between sleep disturbances, catastrophizing, and knee pain in older and middle-aged adults. At baseline, 10% of the 3,813 individuals experienced catastrophizing, while 24% experienced knee discomfort. Knee pain (prevalence ratio [PR] 1.4-2.0, P trend <0.001) and catastrophizing (PR 1.4-3.1, P trend <0.001) were more prevalent in participants with poorer sleep disturbance. The risk of knee pain (risk ratio [RR] 1.1, P trend <0.001) and catastrophizing (RR 1.2-1.7, P  trend <0.001) during follow-up were predicted by sleep disturbance at baseline. Initially, knee pain and catastrophizing respectively mediated the associations between sleep and pain and between sleep and catastrophizing. Over time, knee pain adversely mediated the sleep-catastrophizing association.

A 2020 study involving 2,329 participants found a correlation between better sleep and reduced worsening of knee pain. The relationship between knee pain worsening and sleep quality was found to be influenced by the presence of widespread pain (P = 0.002 for interaction). Researchers also discovered that the strongest association with sleep quality was observed in individuals with more than 8 painful joint sites (P trend <0.01), while no significant association was found in individuals with 2 painful joint sites. Among those with widespread pain, individuals with very good sleep quality had an odds ratio of 0.53 (95% CI 0.35-0.78) for knee pain worsening (P trend <0.001) compared to those with poor sleep quality. Similar findings were observed when restless sleep and widespread pain were considered. Additionally, a significant cross-sectional correlation was found between sleep quality and the prevalence of persistent, frequent knee discomfort.

These studies collectively demonstrate the interrelationships among the risk of catastrophizing, the prevalence of sleep disturbance, and knee discomfort. However, further research with long-term comprehensive and objective sleep assessments is needed to clarify how sleep affects knee pain in the presence of other coexisting conditions causing discomfort.


  1. Wang Y, Li X, Zhang Y, Ma Y, Xu S, Shuai Z, Pan F, Cai G. Association of sleep disturbance with catastrophizing and knee pain: Data from the Osteoarthritis Initiative. Arthritis Care & Research. 2023 Apr 11.
  2. Dai Z, Neogi T, Brown C, Nevitt M, Lewis CE, Torner J, Felson DT. Sleep quality is related to worsening knee pain in those with widespread pain: the multicenter osteoarthritis study. The Journal of rheumatology. 2020 Jul 1;47(7):1019-25.