0910 Sleep-pain Behaviors Predict Insomnia, Pain, and Physical Function over One Year Following Total Knee Arthroplasty in Individuals with Knee Osteoarthritis

Abstract

Introduction: Cognitive behavioral theory for insomnia posits that maladaptive efforts to cope with pain, such as retiring to the bed/bedroom when in pain and taking extra pain medications to promote sleep, paradoxically contribute to persistent insomnia, a known risk factor for pain chronification. The present study evaluated sleep-pain behaviors and their concurrent and longitudinal associations with insomnia, pain, and physical function in individuals with knee osteoarthritis (KOA) undergoing total knee arthroplasty (TKA). Secondary analyses examined insomnia as a mediator between sleep-pain behaviors and functional outcomes. Methods: Participants were 109 individuals (Age: M=63.9; SD=8.8; 54% female) with KOA scheduled to undergo TKA. Measures were collected at baseline and at 6 (n=73), 13 (n=73), 26 (n=87), and 52 (n=107) weeks following TKA. Measures included: the 3-item Sleep-Pain Behaviors Survey (SPBS); the Insomnia Severity Index (ISI); actigraphy (sleep onset latency [SOL], sleep efficiency [SE%], wake after sleep onset [WASO], and total sleep time [TST]); the Brief Pain Inventory (BPI); and the Physical Function subscale from the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Analyses used linear mixed-effects regression analyses, controlling for time, concurrent depression, and concurrent levels of each outcome. Results: Beyond its concurrent association with ISI (B=1.12, p