WEST PALM BEACH, Fla. — Sleep disorders and other markers of poor sleep are substantially more common among people with osteoarthritis (OA) than those without, and such patients also experience more pain and depression, according to research presented at the World Congress on Osteoarthritis (OARSI) 2026 Annual Meeting.

“Sleep disorders can significantly affect the severity of pain and functional impairment” in people with OA, Sylvain Mathieu, MD, PhD, of the University of Clermont Auvergne and CHU Clermont-Ferrand in Clermont-Ferrand, France, told attendees. “A systematic assessment of sleep disorders in osteoarthritis patients, along with targeted management, should be integrated into future therapeutic recommendations to improve overall patient care.” 

The findings were also published in the March 2026 issue of Osteoarthritis and Cartilage Open.

Many patients with OA experience symptoms that include fatigue, anxiety, depression, and sleep problems, and conditions like sleep disorders can exacerbate pain, fatigue, and mood while also impairing their physical function and quality of life, Mathieu told attendees. 

‘Rarely Addressed in Recommendations’

Despite a substantial proportion of patients reporting sleep disorders, however, “this issue is rarely addressed in recommendations on osteoarthritis management,” and the prevalence of sleep disorders in these patients has not been systematically assessed, he said.

Mathieu and his colleagues therefore identified all observational studies through July 2025 that assessed both sleep disorders and OA in PubMed, Embase, Web of Science, and Cochrane Library databases. They found 81 papers involving 289,914 patients. About a quarter of the patients had knee OA (n = 75,129; 25.9%); 708 had hand OA; 236 had hip OA; and the remaining participants had OA in multiple locations, or the location was not noted.

The data they extracted from these studies included patient characteristics, pain scales, total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, prevalence of different sleep disorders, average hours of sleep, sleep quality on a visual analog scale (VAS; 0-10), sleep efficiency (0%-100%), and average scores on the Pittsburgh Sleep Quality Index (PSQI; 0-21). 

The meta-proportional prevalence of sleep disorders was 68.9% across all the studies’ participants, including a third with sleep apnea (32%), a third with insomnia (34%), and about half with restless leg syndrome (51.6%). Over half (59.2%) had poor sleep, defined as a PSQI score > 5, and nearly a third (31.9%) got less than 6 hours of sleep per night on average.

The prevalence of sleep disorders and other markers of poor sleep was higher in the patients with OA than in those without it. Independent from the meta-proportional analysis, the prevalence of sleep disorders was 31.2% in those with OA and 23.2% in those without it (odds ratio [OR], 1.5; P = .03). More patients with OA had sleep apnea (17.9%) than those without OA (13%; OR, 1.8; P < .001). About twice as many patients with OA had poor sleep (58.5%) compared with those without OA (28.2%; OR, 1.98; P < .001).

Total average hours of sleep per night were not statistically different between those with (7 hours) and without (6.8 hours) OA, but sleep efficiency was poorer in those with OA (82% vs 90%; P = .02). The average PSQI score was also significantly higher in those with OA (7.9) than without (6.5; P = .002).

Among patients with OA, those who had sleep disorders were more likely to be younger (60.7 years vs 64 years; P < .001) and have a higher BMI (32 vs 29.5; P < .001). They were also more likely to have a higher pain intensity on VAS (4.4 vs 2.9), a higher total WOMAC score (5.9 vs 2.8), and a higher level of pain catastrophism (18 vs 9.9; P < .001 for all). 

For patients with OA, the likelihood of having depression was more than 13-fold higher among those with sleep disorders than those without a sleep disorder (32.5% vs 3.8%; OR, 13.1; P < .001). The only demographic characteristic significantly associated with sleep disorders was being a woman (P < .001).

‘Start Screening for Sleep Problems’

Michelle Hall, PhD, MS, associate professor of musculoskeletal health at the University of Sydney in Camperdown, Australia, was not involved with the research but told Medscape Medical News that she found the study really interesting.

“A lot of people thought that [sleep problems] were a symptom of having osteoarthritis, but I think there’s more and more data to suggest that sleep is potentially partly driving symptoms” of OA, Hall said. She was grateful to see this meta-analysis because it suggested that clinicians now need to consider the possibility of a bidirectional relationship rather than focusing primarily on the idea that the pain alone is interfering with good sleep.

“I think, at a minimum, it means [clinicians] need to start screening for sleep problems” in patients with OA, said Hall, who is currently conducting trials that specifically target improving sleep in order to help improve pain in people with OA. 

“Rather than managing [poor sleep] as a symptom, we’re actually combining it with exercise to see if we can do better than with exercise alone,” Hall said. “When you do cognitive behavioral therapy for insomnia, the effects on pain are the same as the effects of exercise in people with osteoarthritis,” she said of preliminary findings in her research.

No external funding was used for this research. Mathieu reported receiving personal fees from Bristol Myers Squibb, Pfizer, AbbVie, Novartis, Roche, Chugai, Tilman, and Merck Sharp & Dohme, unrelated to this work. Hall reported having no disclosures.

Tara Haelle is a science/health journalist based in Dallas.