UA Researcher Finds Links among Depression, Sleep Problems, Osteoarthritis

TUSCALOOSA, Ala. — Osteoarthritis, for many people, isn’t a “what if” – it’s a matter of “when.”

As normalized as the degenerative joint disease has become, analyses beyond discomfort and disability have been limited. And, while osteoarthritis, pain and depression have been previously linked, the dynamic with sleep disturbances and long-term well-being haven’t been explored.

Dr. Patricia Parmelee, director for the Center for Mental Health & Aging at The University of Alabama, has discovered links between high levels of pain and symptoms of depression exacerbated by a combination of sleep disturbances due to pain.

A four-year study of 367 people in Philadelphia, Pennsylvania showed participants with greater symptoms of depression had experienced more pain and worsened sleep problems. Additionally, the study showed, a combination of sleep disturbance and high pain at baseline led to much greater depression.

Parmelee also found the initial extent of sleep disturbance, alone, predicted functional decline over the 1-year period.

“What we add is a focus on depression over time and how sleep disturbance both affects the experience of osteoarthritis and its long-term impact, but also how it interacts with discomfort to affect depression,” Parmelee said. “Cross-sectionally, we see an association with depression and pain and OA, and, when someone has sleep disturbances, they’re at high risk of depression.”

Parmelee’s findings were recently published in Arthritis Care and Research, a journal of the American College of Rheumatology.

The study included older adults who had been previously diagnosed with osteoarthritis in their knees. The participants were interviewed three times over two years. The original scope of the study was to measure how osteoarthritis affected the fun things participants liked to do, like exercising or gardening. Participants were outfitted with actigraphs to monitor physical activity.

“We weren’t thinking about sleep with the original study,” Parmelee said. “It wasn’t on my radar until after data had been collected. I’d been getting interested in sleep because of the connection between sleep and depression.

“I hadn’t thought about looking at sleep until I began talking with Natalie D. Dautovich (clinical geropsychology professor at UA), who studies late-life sleep. We were talking one day, and I told her, ‘we have variables we could look at.’ It was a spin-off of shared interest that’ll lead to much more in-depth research.”

A new goal is to determine how osteoarthritis interacts with the body to cause sleep disturbances and depression, Parmelee said. Ultimately, follow-up research will help determine the proper way to intervene in treatment.

Parmelee’s new study, which has a more “fine-grained” look at the connection between osteoarthritis and sleep, is based in Tuscaloosa and funded by the National Institute on Aging.

The Center for Mental Health and Aging is part of UA’s College of Arts and Sciences.