# Pain, post-traumatic stress, and sleep disturbance in older adults with knee osteoarthritis: a path analysis of the mediating effect of depression and social support

## TL;DR

This study finds that nearly half of older adults with knee osteoarthritis experience poor sleep, influenced by pain, depression, and low social support.

## Contribution

The study identifies depression as a key mediator linking pain, PTSD, and sleep disturbance in older adults with knee osteoarthritis.

## Key findings

- Depressive symptoms were the strongest predictor of poor sleep quality (β = 0.396).
- Pain and PTSD indirectly affect sleep through depressive symptoms.
- Social support and psychological distress are critical factors in sleep disturbance among older KOA patients.

## Abstract

Sleep disturbance is a prevalent and debilitating comorbidity in older patients with knee osteoarthritis (KOA), significantly impacting their quality of life. While pain is a known contributor, the complex interplay between physical symptoms, psychological distress, and social factors remains inadequately understood. This study aimed to determine the prevalence of poor sleep quality and to elucidate the intricate pathways through which pain, post-traumatic stress symptoms (PTSD), and social support influence sleep among community-dwelling older KOA patients.

A multi-stage cluster random sampling method was employed to recruit 314 older patients with KOA from communities in Changsha. Data were collected on demographic characteristics, sleep quality (Pittsburgh Sleep Quality Index, PSQI), pain severity (Numerical Rating Scale, NRS), social support (Social Support Rating Scale), and symptoms of anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and PTSD (Posttraumatic Stress Disorder Checklist-Civilian Version, PCL-C). Poor sleep quality was defined as a PSQI global score > 7. Multivariable logistic regression and path analysis were performed to identify influencing factors and mediating pathways.

The prevalence of poor sleep quality (PSQI > 7) was 49.0% (154/314), with a mean cohort PSQI score of 8.18 ± 4.39. Bivariate analyses revealed that poor sleep quality was significantly associated with female gender, lower educational attainment, greater pain severity, higher levels of depressive and anxiety symptoms, higher PTSD scores, and lower social support (all p < .001). Path analysis, using a well-fitting model (TLI = 0.961, RMSEA = 0.070), identified depressive symptoms (total effect β = 0.396) and pain (total effect β = 0.329) as the most significant predictors of poorer sleep quality. The model further revealed that depressive symptoms played a crucial mediating role, channeling the indirect effects of both pain and PTSD onto sleep.

Nearly half of the community-dwelling older adults with KOA suffer from poor sleep quality, underscoring a significant health burden. The risk is driven by a complex web of factors, not limited to pain. Our findings highlight that depressive symptoms and social support are critical mediators in the relationship between pain, trauma, and sleep. This suggests that effective management of sleep disturbances in this population necessitates a holistic, integrated approach that combines pain control with routine screening and management of psychological distress and reinforcement of social support systems.