All ETDs from UAB

Advisory Committee Chair

S Justin Thomas

Advisory Committee Members

Burel Goodin

Casey Azuero

Olivio Clay

Robert E Sorge

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences


Knee osteoarthritis (OA) is often accompanied by insomnia symptoms, character-ized by difficulty falling asleep, maintaining sleep, or both. Among individuals with knee OA, up to 31% report significant difficulty falling asleep, 81% have difficulties staying asleep, and up to 77% report any sleep problem. However, the sleep and pain relationship has also rarely been evaluated using objective and subjective sleep measures. Thus, this study attempted to characterize objective and subjective sleep variables in a diverse sam-ple of individuals with symptomatic knee OA. Further, the impact of objective and sub-jective sleep quality on clinical pain severity, movement-evoked pain, and physical func-tion change across time was explored. Furthermore, this study examined racial/ethnic dif-ferences stratified by levels of neighborhood disadvantage with our variables of interest both at baseline and across time. Lastly, we examined the relationship between pain catastrophizing and clinical pain severity and the mediating role of sleep quality. Results showed that individuals living with symptomatic knee OA had reported worse subjective sleep quality and reductions to objective sleep quality compared to healthy controls. Ob-jective and subjective sleep quality were associated with clinical pain severity, move-ment-evoked pain, and declines in physical function depending on the mode of sleep measurement. Objective/subjective sleep quality was not predictive of change scores of clinical pain, MEP, and physical function measures. Racial/ethnic group differences were iii demonstrated in that NHB individuals reported increased clinical pain severity, MEP, and reductions in physical function. Analyses examining neighborhood disadvantages showed that individuals living in areas with more disadvantages had significant reductions in physical function scores. Multimodal sleep disturbance mediated the relationship between pain catastrophizing and clinical pain severity. Moderated mediation was present for NHW individuals in the relationship between pain catastrophizing and clinical pain se-verity via subjective sleep on the Insomnia Severity Index. These results provide initial support for neighborhood disadvantage as a risk factor for adverse pain outcomes in knee OA. Health providers should assess and target pain catastrophizing and multimodal sleep disturbance as clinical interventions when managing individuals living with symptomatic knee OA.



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