Prevalence and impact of sleep disorders in osteoarthritis: A systematic review and meta-analysis

Sleep disorders (SD) are increasingly recognized as a major contributor to the symptom burden of osteoarthritis (OA), yet their epidemiology and clinical impact remain insufficiently characterized. This systematic literature review with meta-analysis aims to quantify the prevalence of SD in OA patients and to assess their influence on patient-reported outcomes.

We searched the PubMed, Embase, Web of Science and Cochrane Library databases up to 22 July 2025 (PROSPERO CRD120251067310). The Pittsburgh Sleep Quality Index (PSQI), sleep efficiency, and the number of patients with SD, including insomnia, sleep apnea and restless legs syndrome (RLS) were collected. The prevalence of SD was calculated using metaproportion. Differences were measured using the inverse variance method or the Mantel-Haenszel method.

We selected 81 articles representing 289,914 patients, including 75,129 knee, 708 hand and 236 hip OA. For the remaining patients, OA location was not noticed or multiple. The prevalence of SD was 68.9 % (63 studies, 276,092 patients), 32.0 % for sleep apnea, 34.0 % for insomnia and 51.6 % for RLS. Compared to healthy controls, the prevalence of SD was higher in OA patients which had poorer sleep quality with a higher PSQI score (7.9 ± 3.4 vs. 6.5 ± 2.7; p = 0.002) and lower sleep efficiency (82.1 ± 12.5 vs. 89.8 ± 6.0 %; p = 0.02). OA patients with SD were younger, had a higher BMI, a greater pain intensity and a higher frequency of depression and catastrophizing.

Sleep disorders are common in OA patients and should be investigated and managed since they have a negative impact on pain, fatigue and disability.