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

Objective To examine racial/ethnic differences in sleep quality and the pain-sleep association among older adults with osteoarthritis of the knee. Design Baseline interview followed by a 7-day microlongitudinal study using accelerometry and self-reports. Setting Participants were community residents in western Alabama and Long Island, NY. Participants 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. Measurements 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. Results 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. Conclusions 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.