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Sex Differences in Sleep Duration among Older Adults with Self-Reported Diagnosis of Arthritis: National Health and Nutrition Examination Survey, 2009-2012.

1. Introduction

Arthritis is a term that has been associated with more than 100 forms of joint pain. Several common types are osteoarthritis (also called degenerative arthritis); rheumatoid arthritis (an autoimmune disease); psoriatic arthritis; and gout. The most common form of joint disease, chronic joint pain, and disability is osteoarthritis [1, 2]. Worldwide, there are an estimated 9.6% of older men and 18% of older women who have osteoarthritis [3]. Degeneration of the cartilage at the joints due to damage from injury, overweight, use, or overuse occurs in weight-bearing joints over time. Knee/hip osteoarthritis was the 11th reason in global disability determined from the Global Burden of Disease Study, 2010 [2]. Pain management/joint replacement are the available treatment options for osteoarthritis [4].

Rheumatoid arthritis occurs when the immune system attacks a person's joints. Joint pain and damage can occur with the associated inflammation. The inflammation is thought to be related to tumor necrosis factor and interleukin-1 causing the immune system to overreact [5]. In addition to painful joints, people with rheumatoid arthritis often feel tired.

In the US psoriatic arthritis occurs in about 11% of people with psoriasis [6]. The prevalence of psoriasis is 0.25% in the US [6]. The skin and joints become inflamed with psoriatic arthritis.

Gout occurs when uric acid crystals concentrate in a joint, typically the big toe. The pain is often associated with excessive drinking, drugs, or stress. Untreated, gout can progress to affect other joints and the kidneys.

Management of the many types of joint pain is specific to the unique causes. Unfortunately, there is a great deal of confusion about arthritis in general when people are not specific about the type of arthritis being discussed.

However, arthritic symptoms from any of the many types of arthritis impact quality of life, trend to disability, and are associated with high economic burdens [7]. Arthritic symptoms are influenced and modified by, as well as influence and modify, many factors including sleep. It is theorized that sleep is restorative, protective, instinctive, conservative, and necessary for a good quality of life, both physically and psychologically [8]. As individuals grow older, sleep duration decreases while waking frequency increases [9, 10]. An individual's sex and health status are two major factors that may account for the variation in sleep patterns observed in studies involving sleep and age [10]. In general, sleep duration for healthy adults is approximately 7-9 hours [9, 11].

1.1. Sleep Studies. For older adults, researchers of a study of 1,026 older adult participants in Paris [12], as well as a study of 66,478 adult participants in Korea [9], indicated a median night-time sleep duration of 7 hours. Researchers using the Behavioral Risk Factor Surveillance System, 2014, reported that more than a third of US adults were sleeping fewer than 7 hours each night [13, 14]. Short sleeping older adults were identified by researchers as sleeping less than 6 hours per night and long sleepers as sleeping more than 9 hours per night in a study on global aging and health in adults who were aged 50 years and above [15]. In the United States, 37.3% of adults aged 45-64 years and 26.3% of adults older than 65 years reported asleep duration of less than 7 hours [13]. There were 62.7% and 73.7%, respectively, who reported more than 7 hours of sleep [13].

1.2. Arthritis and Sleep Studies. Individuals with arthritis are thought to have a bidirectional relationship of arthritic symptoms and sleep duration [16]. Fatigue in participants with rheumatoid arthritis (RA) was shown to be associated with poor sleep quality in a small sample (n = 158) of older adults in the United States [17], and in a sample (n = 986) of participants from Norway [18]. Previous researchers have indicated that certain disease prevalences were affected by sleep duration. Sleep and arthritis have been investigated, but few researchers have evaluated subgroups. The researchers conducting analyses involving subgroups by race/ethnicity in the United States found no differences in total sleep time in older adults with osteoarthritis (n = 124) [19]. Similar research of older adults with arthritis based upon sex has been limited to a study using Korea National Health and Nutrition Examination Survey 2010-2013 data, in which researchers did find a relationship of sleep duration and osteoarthritis [16].

The purpose of this research is to investigate sleep duration by sex among older adults in the United States who have self-reported diagnosis of arthritis using data from the National Health and Nutrition Examination Survey, 20092012. The null hypothesis is that the odds for sleep duration for people with self-reported diagnosis of arthritis are equal to the odds for sleep duration for people without self-reported diagnosis of arthritis, stratified by sex with an a priori P value established at < 0.05.

The Krieger Ecosocial epidemiological theory was used for the theoretical framework of the study. In the theory many factors should be included when attempting to determine associations with the embodiment of an outcome/condition/disease including those which are biological, behavioral, and physical/environmental, and those related to accountability and agency within societal and ecosystem levels from the individual, to households, groups, regions, and nations and globally over the course of life [20]. In this framework, sleep duration is expected to have a biological difference with sex hormones and the reproductive system contributing as factors, as well as sex, differences in work, recreation, lifestyle, habits, stress, psychosocial factors, healthcare access, etc. [8].

2. Materials and Methods

The National Health and Nutrition Examination Surveys (NHANES) from years 2009-2010 and 2011-2012 (from which the data for this study were extracted) were conducted under two National Center for Health Statistics Research Ethics Review Board protocols: (1) Protocol Continuation of 200506 (for NHANES 2009-2010) and (2) Protocol 2011-17 (for NHANES 2011-2012). The West Virginia University Institutional Review Board provided ethics acknowledgement of this secondary data analysis study of the existing, publicly available, deidentified NHANES data as being nonhuman subject research under Protocol Number 1803045894.

2.1. Study Design, Data Source, and Data Availability. The researchers used the combined NHANES, 2009-2010 and 2011-2012, data source, as mentioned above. This study had a cross-sectional, observational, epidemiological research design, based upon the study design of Jung et al. [16]. Guidelines from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were followed for this study.

The researchers who completed the NHANES used a stratified, multistage probability sampling design for the NHANES 2009-2012 surveys. The participants were noninstitutionalized United States civilians with an oversampling of minority subgroups. The NHANES data for this study are publicly available. Additional information about the NHANES and access to the data are available at https://wwwn .cdc.gov/nchs/nhanes/Default.aspx.

2.2. Study Sample. The inclusion criteria for participants in this study of self-reported diagnosis of arthritis and sleep duration were that participants were aged 50 years or above, and that they had no missing data on self-reported diagnosis of arthritis status, number of hours that are routinely slept, sex, race/ethnicity, education, smoking, insurance, body mass index, and self-perceived health status.

2.3. Measures: Main Variables of Interest. The study's main variables were self-reported diagnosis of arthritis and sleep duration. The self-reported diagnosis of arthritis variable was created from a question posed to NHANES participants about their arthritis status (yes/no). The question was: "Has a doctor or other health professional ever told you that you had arthritis?" [21]. Sleep duration/the number of hours of sleep was created from a question posed to NHANES participants about the number of hours routinely slept by the participants: "How much sleep do you get (hours)?" [21].

2.4. Measures: Covariables. Other variables for the study were sex (male; female), race/ethnicity (non-Hispanic White, non-Hispanic Black, Mexican-American, and other), age (50 to less than 60, 60 and above), smoking status (current smokers, former smokers, and never smokers), body mass index (less than 25, 25 to less than 30, and 30 and above), insurance (insured, not insured), and self-perception of health (excellent/very good, good, and fair/poor).

2.5. Statistical Analyses. The statistical tests used in this study were Chi square tests for bivariate associations between self-reported diagnosis of arthritis and the other variables. Unadjusted logistic regression analyses were used to determine the association of arthritis and the sleep variable (1) in overall analyses; (2) in subgroup analysis by females; and (3) in the subgroup analysis by males. The adjusted logistic regression analyses included the other variables listed above. Sampling weights, primary sampling units, domain, and strata were accounted for in the data analyses. The analyses were completed with the Statistical Analysis System Software (SAS[R] version 9.3, SAS Institute, Inc., Cary, NC, USA).

3. Results

3.1. Study Sample Description. This study included 4,888 participants. There were 76.7 (weighted) % non-Hispanic White participants, 9.9% non-Hispanic Black participants, 4.2% Mexican-American participants, and 9.2% other participants. More participants were aged 60 years and older, had more than a high school education, and slept 6-7 hours (57.7%, 57.8%, and 51.4%, respectively). There were 41.6% (n = 2,132) of the participants who self-reported a diagnosis of having arthritis. Of the participants with a self-reported diagnosis of arthritis, 60.6% were female. Sample details are presented in Table 1.

3.2. Bivariate Associations with Self-Reported Diagnosis of Arthritis. Also presented in Table 1 are the bivariate associations of self-reported diagnosis of arthritis and the other variables. For the main variable of interest, hours of sleep, 15.2% of participants with a self-reported diagnosis of arthritis reported sleeping 2-5 hours as compared with 10.9% of the people who did not self-report a diagnosis of arthritis (P = .0004). In bivariate analysis of self-reported diagnosis of arthritis and sleep stratified by sex, there were significantly more people with self-reported diagnosis of arthritis who slept 2-5 hours for both women (P = 0.0192) and men (P = 0.0231).

Other significant overall bivariate associations with self-reported diagnosis of arthritis were with race/ethnicity, age, education, smoking, body mass index, insurance, and perceived health status. More people who were non-Hispanic Black (44.8%) and non-Hispanic White (42.2%) self-reported a diagnosis of arthritis than people who were Mexican-American (35.6%) (P = 0.0013). The race/ethnicity relationship with self-reported diagnosis of arthritis was not significant when stratified by sex for males. It remained significant; for females there were 25.6% of Mexican-American females who self-reported a diagnosis of arthritis compared with 36.0% of non-Hispanic Black women and 36.1% of non-Hispanic White women (P = 0.0115).

More adults aged 60 years and above, as compared with adults aged 50-59, self-reported diagnosis of arthritis (48.4% as compared to 32.3%, P < .0001). The results remained significant concerning age and self-reported diagnosis of arthritis in subgroup analysis for females, as well as for males (P < .0001).

People with a high school education or less were more likely to report a diagnosis of arthritis (44.5%) as compared with people having more than a high school education (39.4%, P = 0.0044). The relationship remained significant concerning education and self-reported diagnosis of arthritis in subgroup analysis for females (P = 0.0143) but failed to reach statistical significance for males (P = 0.7210).

There were 38.1% of never smokers who reported a diagnosis of arthritis, as compared with 46.2% of former smokers and 42.2% of current smokers (P = 0.0012). The relationship remained significant concerning smoking status and diagnosis of arthritis in subgroup analysis for females (P = 0.0055) and males (P < .0001).

People with a body mass index of 30 and above and people with a body mass index of 25-29 were more likely to report a diagnosis of arthritis (38.6% and 36.1%, respectively) as compared with people with a body mass index of 24 or less (25/4%, P < .0001). The relationship remained significant concerning body mass index and self-reported diagnosis of arthritis for both females (P < .0001) and males (P = .0002).

People who did have insurance were more likely to self-report a diagnosis of arthritis as compared with people who did not have insurance (43.0% versus 29.7%, P = 0.0002). The relationship failed to remain significant for females. There were 37.0% of males with insurance and 19.2% of males without insurance who self-reported a diagnosis of arthritis (P < .0001).

There were 55.8% of people with a self-perception of fair/poor health who reported a diagnosis of arthritis as compared with 45.5% of people with a self-perception of good health and 31.4% of people with a self-perception of excellent/very good health who reported arthritis (P < .0001). The relationship of perceived health status and self-reported diagnosis of arthritis remained significant in subgroup analysis for males and females (P < .0001).

3.3. Results of Logistic Regression Analyses. Overall unadjusted and adjusted logistic regression analyses and sex subgroup unadjusted and adjusted logistic regression analyses are presented in Table 2. The overall unadjusted odds ratio (OR) of having self-reported a diagnosis of arthritis and sleeping 2-5 hours was 1.49 [95% Confidence interval (CI): 1.18, 1.87; P < .0001] as compared with sleeping 6-7 hours. It remained significant in the adjusted model in which the adjusted OR was 1.35 [95% CI: 1.08, 1.70; P = 0.0103].

Stratified by the female sex, the unadjusted OR of having self-reported diagnosis of arthritis and sleeping 2-5 hours was 1.56 [95% CI: 1.14, 2.13; P = 0.0190] as compared with sleeping 6-7 hours. However, the relationship was attenuated and failed to reach significance in the adjusted model in which the adjusted OR was 1.29 [95% CI: 0.94, 1.77; P = 0.1132].

Stratified by the male sex, the unadjusted OR of having self-reported diagnosis of arthritis and sleeping 2-5 hours was 1.41 [95% CI: 0.98, 2.02; P = 0.0622] as compared with sleeping 6-7 hours. In the adjusted model, the adjusted OR was 1.40 [95% CI: 0.94, 2.08; P = 0.0977]. Both unadjusted and adjusted failed to reach significance.

4. Discussion

Previous researchers have reported that there are certain disease prevalences and outcomes that were found to be associated with hours of sleep. For example, Katsagoni et al. reported that having a healthy diet-optimal sleep lifestyle was inversely associated with liver stiffness and insulin resistance [22]. Yeo et al. reported that mortality from cardiovascular disease and respiratory disease increased in participants who slept [less than or equal to]5 hours as compared with participants who slept 7 hours [23]. Choi et al. reported an increase in atopic dermatitis and asthma in females with sleep duration <5 hours compared with participants who slept 7 hours [24]. And Jung et al., who evaluated data from patients who had knee or hip joint radiography, reported that male patients who slept 0-3 hours and 4-5 hours had adjusted odds ratio of 2.28 and 1.38 for osteoarthritis, respectively, as compared with patients who slept 6-7 hours; and, for the women patients, the respective adjusted odds ratios for osteoarthritis were 1.63 and 1.26 [16].

The researchers for this study examined the relationship between self-reported diagnosis of arthritis and sleep duration in older adults, aged 50 years and above. The most common sleep duration category was 6-7 hours. Few participants (12.7%) reported limited sleep (2-5 hours per night). The self-reported diagnosis of arthritis was high (41.6%) in this group of older adults. Overall, there was a relationship of limited sleep and self-reported diagnosis of arthritis (adjusted odds ratio: 1.35 [95% CI: 1.08, 1.70; P = 0.0103]). Adjusted odds ratios stratified by male or female sex failed to reach significance.

4.1. Similar Studies in Support of or in Contrast to This Study's Results. Jung et al. conducted a study in Korea and reported the adjusted odds ratios for osteoarthritis based upon hours of sleep for men (3.22) and women (2.05), both of which were statistically significant [16]. Although the adjusted overall relationship of self-reported diagnosis of arthritis (the variable used in this study) was significant and positive in this study (1.35), the adjusted odds ratios for females (1.29) and males (1.40), although positive, were not statistically significant. Jung et al. study's variable was osteoarthritis based upon a radiographic criterion of a knee/hip joint Kellgren-Lawrence grade of 2 or above, whereas self-reported diagnosis of arthritis was the variable used in this study.

The findings of this study were similar to a study conducted by Dai and Hao in 2017 who used 2014 Behavioral Risk Factor Surveillance System data and found significant associations of very short sleep duration, less than 5 hours, and arthritis, but failed to find significance in sleep duration and sex [14]. Researchers of a recent study of 2,682 people, aged 45 years and above, with/without symptomatic osteoarthritis of the knee or hip in Johnston County, NC, US, reported that 55% of all individuals in the study had insufficient sleep and the individuals with symptomatic osteoarthritis had an unadjusted odds ratio of 1.35 (95% CI 1.12-1.62) for insufficient sleep as compared with individuals who did not have symptomatic osteoarthritis of the knee or hip [25]. The overall unadjusted odds ratio for this current study is in agreement with the Johnston County, NC, US, study's overall results which was one of the first to investigate sleep disturbances in people with/without osteoarthritis [25].

Researchers in Egypt used the Pittsburgh Sleep Quality Index (PSQI) and compared men and women with/without arthritis and reported that "poor sleepers" (who were identified using PSQI definitions) were more likely to have arthritis, but no significant association between the PSQI and gender was reported [26]. These overall results of no differences in sleep duration between men and women are similar to the results of a meta-analysis of sleep in adults aged 58 years and above [8].

4.2. Study Strengths and Limitations. A study strength was the use of a large, valid, consistently running, and nationally representative study of United States residents. As this was a large study, many factors known to influence arthritis and sleep could be included in the analyses to allow for adjusted odds ratios and the influence of other factors. Another strength is the use of categories consistent with previous research [16] so that any future meta-analysis would have greater validity. The use of categories, rather than specific number of hours, also helps in reducing the potential for self-reporting errors.

A characteristic of cross-sectional epidemiological studies (rather than a specific limitation) is that causation cannot be inferred. This does limit the results of this or any cross-sectional study in terms of assessing causation. Therefore, epidemiological studies are often followed by clinical studies to document temporal associations.

Another limitation of this study was the use of self-reports for both diagnosis of arthritis and sleep duration. Self-reports can be influenced by poor recall of the participants, or by a desire to respond to the interviewer in a socially acceptable manner (social desirability bias), or by misunderstanding a question. The question posed to the participants about arthritis was a general question as to if he or she had received a diagnosis for arthritis. The type of arthritis was not specified. There is a potential that the participant understood the question to only mean osteoarthritis or rheumatoid arthritis. However, self-reports are often used in epidemiological studies, and the NHANES researchers have developed their surveys to be valid and reliable over the years since the NHANES began in 1971.

5. Conclusion

Our results, and those of other researchers, highlight the importance of adequate sleep duration. In this analysis of noninstitutionalized older adults in the United States, the prevalence of a self-reported diagnosis of arthritis was associated with shorter sleep duration in the overall analyses, but the association failed to reach significance when stratified by sex.

https://doi.org/10.1155/2018/5863546

Data Availability

Previously reported and published data from the National Health and Nutrition Examination Survey, 2009-2012, were used in this study and are available at https://wwwn.cdc.gov/ nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2011. The dataset is cited at relevant places within the text as reference [21].

Disclosure

The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflicts of Interest

The authors have no financial, economic, or professional interests to disclose.

Acknowledgments

The research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award no. U54GM104942.

References

[1] M.-E. Pickering, R. Chapurlat, L. Kocher, and L. Peter-Derex, "Sleep Disturbances and Osteoarthritis," Pain Practice, vol. 16, no. 2, pp. 237-244, 2016.

[2] M. Cross, E. Smith, D. Hoy et al., "The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study," Annals of the Rheumatic Diseases, vol. 73, no. 7, pp. 1323-1330, 2014.

[3] A. D. Woolf and B. Pfleger, "Burden of major musculoskeletal conditions," Bulletin of the World Health Organization, vol. 81, no. 9, pp. 646-656, 2003.

[4] S. Glyn-Jones, A. J. Palmer, R. Agricola et al., "Osteoarthritis," The Lancet, vol. 386, no. 9991, pp. 376-387, 2015.

[5] W. P. Arend and J. M. Dayer, "Inhibition of the production and effects of interleukins-1 and tumor necrosis factor a in rheumatoid arthritis," Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, vol. 38, no. 2, pp. 151-160, 1995.

[6] J. M. Gelfand, D. D. Gladman, P. J. Mease et al., "Epidemiology of psoriatic arthritis in the population of the United States," Journal of the American Academy of Dermatology, vol. 53, no. 4, pp. 573-577, 2005.

[7] M. Hiligsmann, C. Cooper, N. Arden et al., "Health economics in the field of osteoarthritis: An Expert's consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)," Seminars in Arthritis and Rheumatism, vol. 43, no. 3, pp. 303-313, 2013.

[8] M. H. Rediehs, J. S. Reis, and N. S. Creason, "Sleep in old age: Focus on gender differences," SLEEP, vol. 13, no. 5, pp. 410-424, 1990.

[9] S. Y. Kim, S.-G. Kim, S. Sim, B. Park, and H. G. Choi, "Excessive sleep and lack of sleep are associated with slips and falls in the adult korean population a population-based cross-sectional study," Medicine (United States), vol. 95, no. 4, pp. 1-8, 2016.

[10] J. A. Floyd, S. M. Medler, J. W. Ager, and J. J. Janisse, "Age-related changes in initiation and maintenance of sleep: A meta-analysis," Research in Nursing & Health, vol. 23, no. 2, pp. 106117, 2000.

[11] S. Mukherjee, S. R. Patel, S. N. Kales et al., "An official American Thoracic Society statement: The importance of healthy sleep: Recommendations and future priorities," American Journal of Respiratory and Critical Care Medicine, vol. 191, no. 12, pp. 1450-1458, 2015.

[12] M. M. Ohayon and M.-F. Vecchierini, "Normative sleep data, cognitive function and daily living activities in older adults in the community," SLEEP, vol. 28, no. 8, pp. 981-989, 2005.

[13] Y. Liu, A. G. Wheaton, D. P. Chapman, T. J. Cunningham, H. Lu, and J. B. Croft, "Prevalence of healthy sleep duration among adults--United states, 2014," Morbidity and Mortality Weekly Report (MMWR), vol. 65, no. 6, pp. 137-141, 2016.

[14] H. Dai and J. Hao, "Sleep Deprivation and Chronic Health Conditions Among Sexual Minority Adults," Behavioral Sleep Medicine, vol. 28, pp. 1-15, 2017.

[15] T. E. Gildner, M. A. Liebert, P. Kowal, S. Chatterji, and J. J. Snodgrass, "Associations between sleep duration, sleep quality, and cognitive test performance among older adults from six middle income countries: results from the Study on Global Ageing and Adult Health (SAGE)," Journal of Clinical Sleep Medicine, vol. 10, no. 6, pp. 613-621, 2014.

[16] J. H. Jung, H. Seok, S. J. Choi et al., "The association between osteoarthritis and sleep duration in Koreans: a nationwide cross-sectional observational study," Clinical Rheumatology, vol. 37, no. 6, pp. 1653-1659, 2018.

[17] P. Katz, M. Margaretten, L. Trupin, G. Schmajuk, J. Yazdany, and E. Yelin, "Role of Sleep Disturbance, Depression, Obesity, and Physical Inactivity in Fatigue in Rheumatoid Arthritis," Arthritis Care & Research, vol. 68, no. 1, pp. 81-90, 2016.

[18] M. Purabdollah, S. Lakdizaji, A. Rahmani, M. Hajalilu, and K. Ansarin, "Relationship between Sleep Disorders, Pain and Quality of Life in Patients with Rheumatoid Arthritis," Journal of Caring Sciences, vol. 4, no. 3, pp. 233-241, 2015.

[19] P. A. Parmelee, B. S. Cox, J. A. DeCaro, F. J. Keefe, and D. M. Smith, "Racial/ethnic differences in sleep quality among older adults with osteoarthritis," Sleep Health, vol. 3, no. 3, pp. 163-169, 2017.

[20] N. Krieger, Epidemiology and the Peoples Health: Theory and Context, Oxford University Press, New York, NY, USA, 2011.

[21] NHANES 2011-2012, https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2011.

[22] C. N. Katsagoni, G. V. Papatheodoridis, M.-V. Papageorgiou et al., "A "healthy diet-optimal sleep" lifestyle pattern is inversely associated with liver stiffness and insulin resistance in patients with nonalcoholic fatty liver disease," Applied Physiology, Nutrition, and Metabolism, vol. 42, no. 3, pp. 250-256, 2017.

[23] Y. Yeo, S. H. Ma, S. K. Park et al., "A prospective cohort study on the relationship ofsleep duration with all-cause and disease-specific mortality in the Korean Multi-Center Cancer Cohort Study," Journal ofPreventive Medicine & Public Health, vol. 46, no. 5, pp. 271-281, 2013.

[24] J. H. Choi, G. E. Nam, D. H. Kim, J. Y. Lee, K. do Han, and J. H. Cho, "Association between sleep duration and the prevalence of atopic dermatitis and asthma in young adults," Asian Pacific Journal of Allergy and Immunology, vol. 35, no. 3, pp. 150-155, 2017.

[25] K. D. Allen, J. B. Renner, B. DeVellis, C. G. Helmick, and J. M. Jordan, "Osteoarthritis and sleep: The Johnston County osteoarthritis project," The Journal of Rheumatology, vol. 35, no. 6, pp. 1102-1107, 2008.

[26] M. I. Abd Elazeem and M. N. Salem, "Can rheumatoid arthritis affect sleep in Egyptian patients?" Egyptian Rheumatologist, vol. 40, no. 1, pp. 11-16, 2017.

R. Constance Wiener (iD), (1) Alcinda K. Trickett Shockey (iD), (2) and Christopher Waters (3)

(1) Dental Practice and Rural Health, P.O. Box 9448, Health Sciences Addition Room 104a, West Virginia University, Morgantown, WV 26506, USA

(2) Department of Dental Hygiene, Robert C Byrd Health Sciences Center North, Room 1192A, West Virginia University, Morgantown, West Virginia 26506, USA

(3) Department of Dental Research, P.O. Box 9448, Health Sciences Addition Room 106a, West Virginia University, Morgantown, WV 26506, USA

Correspondence should be addressed to R. Constance Wiener; rwiener2@hsc.wvu.edu

Received 6 June 2018; Revised 5 July 2018; Accepted 9 July 2018; Published 1 August 2018

Academic Editor: Liborio Parrino
Table 1: Sample characteristics according to self-reported diagnosis
of arthritis, n = 4,888, ages 50 years and above, from National Health
and Nutrition Examination Survey, 2009-2012.

Category                      Total              Total

                                          Arthritis    no Arthritis

                            n     wt%     n     wt%     n     wt%

Sex
  Female                   2455   52.9   1260   47.6   1195   52.4
  Male                     2433   47.1   872    34.8   1561   65.2
Race/Ethnicity
  NHW                      2281   76.7   1092   42.2   1189   57.8
  NHB                      1134   9.9    514    44.8   620    55.2
  Mex-Am                   584    4.2    214    35.6   370    64.4
  Other                    889    9.2    312    35.3   577    64.7
Age (years)
  50-59                    1590   42.3   518    32.3   1072   67.7
  60 and above             3298   57.7   1614   48.4   1684   51.6
Education
  [less than or            2593   42.2   1185   44.5   1408   55.5
    equal to]HS graduate
  >HS                      2295   57.8   947    39.4   1348   60.6
Smoking
  Current                  792    15.3   337    42.2   455    57.8
  Former                   1681   35.0   810    46.2   871    53.8
  Never                    2415   49.7   985    38.1   1430   61.9
Body Mass
Index
  0-24                     1213   25.4   441    37.3   772    62.7
  25-29                    1733   36.1   680    36.6   1053   63.3
  30 and above             1942   38.6   1011   49.0   931    51.0
Hours of sleep
  2-5                      800    12.7   402    49.8   398    50.2
  6-7                      2339   51.4   980    40.0   1359   60.0
  8-9                      1598   33.6   671    39.9   927    60.0
  10 and above             151    2.4     79    53.9    72    46.1
Insurance
  Yes                      4171   89.1   1924   43.0   2247   57.0
  No                       717    10.9   208    29.7   509    70.3
Perceived
Health Status
  Excellent/v good         1572   42.6   543    31.4   1029   68.6
  Good                     1884   37.4   820    45.5   1064   54.5
  Fair/Poor                1432   29.0   769    55.8   663    44.2

Category                   P-value          Female (n = 2455)

                                       Arthritis   no Arthritis

                                      n     wt%     n     wt%

Sex
  Female                   <.0001
  Male
Race/Ethnicity
  NHW                      0.0013    621    47.7   518    52.3
  NHB                                299    51.9   270    48.1
  Mex-Am                             139    46.8   145    53.2
  Other                              201    42.4   262    57.6
Age (years)
  50-59                    <.0001    310    37.3   475    62.7
  60 and above                       950    54.4   720    45.6
Education
  [less than or             .0044    721    52.4   586    47.6
    equal to]HS graduate
  >HS                                539    44.0   609    56.0
Smoking
  Current                   .0012    173    56.6   126    43.4
  Former                             371    51.2   277    48.8
  Never                              716    43.9   792    56.1
Body Mass
Index
  0-24                     <.0001    270    41.3   345    58.7
  25-29                              354    42.6   407    57.4
  30 and above                       636    56.1   443    43.9
Hours of sleep
  2-5                       .0004    238    57.0   170    43.0
  6-7                                579    45.9   598    54.1
  8-9                                399    45.9   398    54.1
  10 and above                        44    56.8    29    43.2
Insurance
  Yes                       .0002    1131   48.1   986    51.9
  No                                 129    42.1   209    57.9
Perceived
Health Status
  Excellent/v good         <.0001    307    35.7   470    64.3
  Good                               488    52.5   459    47.5
  Fair/Poor                          465    65.0   266    35.0

Category                   P-value          Male (n= 2433)

                                       Arthritis   no Arthritis

                                      n     wt%     n     wt%

Sex
  Female
  Male
Race/Ethnicity
  NHW                       .0848    471    36.1   671    63.9
  NHB                                215    36.0   350    64.0
  Mex-Am                              75    25.6   225    74.4
  Other                              111    27.1   315    72.9
Age (years)
  50-59                    <.0001    208    27.2   597    72.8
  60 and above                       664    41.0   964    59.0
Education
  [less than or             .0143    464    35.4   822    64.6
    equal to]HS graduate
  >HS                                408    34.3   739    65.7
Smoking
  Current                   .0055    164    31.9   329    68.1
  Former                             439    42.1   594    57.9
  Never                              269    28.6   638    71.4
Body Mass
Index
  0-24                     <.0001    171    31.6   427    68.4
  25-29                              326    31.2   646    68.8
  30 and above                       375    40.5   488    59.5
Hours of sleep
  2-5                       .0192    164    41.9   228    58.1
  6-7                                401    33.9   761    66.1
  8-9                                272    32.3   529    67.7
  10 and above                        35    50.0    43    50.0
Insurance
  Yes                       .2814    793    37.0   1261   63.0
  No                                  79    19.2   300    80.8
Perceived
Health Status
  Excellent/v good         <.0001    236    26.2   559    73.8
  Good                               332    38.2   605    61.8
  Fair/Poor                          304    45.6   397    54.4

Category                   P value

Sex
  Female
  Male
Race/Ethnicity
  NHW                       .0115
  NHB
  Mex-Am
  Other
Age (years)
  50-59                    <.0001
  60 and above
Education
  [less than or             .7210
    equal to]HS graduate
  >HS
Smoking
  Current                  <.0001
  Former
  Never
Body Mass
Index
  0-24                      .0002
  25-29
  30 and above
Hours of sleep
  2-5                       .0231
  6-7
  8-9
  10 and above
Insurance
  Yes                      <.0001
  No
Perceived
Health Status
  Excellent/v good         <.0001
  Good
  Fair/Poor

Hours of sleep were 2 to less than 5.5, 5.5 to less than 7.5, 7.5 to
less than 9.5, and 9.5 and above. Age was 50 to less than 60 and 60-
above. Body mass index was 0 to less than 25, 25 to less than 30, and
30-above. wt, weighted; NHW, non-Hispanic White; NHB, non-Hispanic
Black; Mex-Am, Mexican-American; <, less than or equal to; HS, high
school; >, greater than; and v, very.

Table 2: Odds ratios (ORs), adjusted odds ratios (AORs), and 95%
confidence intervals (CIs) of sleep from logistic regression on self-
reported diagnosis of arthritis National Health and Nutrition
Examination Survey, 2009-2012, data.

                           Unadjusted Logistic Regression

                              OR [95% CI]      P value

OVERALL (n = 4,888)
Sleep
  2-5 hours                1.49 [1.18,1.87]    <.0001
  6-7 hours                    reference
  8-9 hours                0.99 [0.82,1.20]    0.9475
  10 hours and above       1.75 [1.17, 2.62]   0.0077
FEMALE ONLY (n = 2,455)
Sleep
  2 -5 hours               1.56 [1.14, 2.13]   0.0190
  6-7 hours                    reference
  8-9 hours                1.00 [0.75,1.32]    0.9796
  10 hours and above       1.55 [0.88, 2.73]   0.1273
MALE ONLY (n = 2,433)
Sleep
  2 -5 hours               1.41 [0.98, 2.02]   0.0622
  6-7 hours                    reference
  8-9 hours                0.93 [0.72,1.21]    0.5807
  10 hours and above       1.95 [1.03, 3.67]   0.0407

                           Adjusted Logistic Regression

                             AOR [95% CI]      P value

OVERALL (n = 4,888)
Sleep
  2-5 hours                1.35 [1.08,1.70]    0.0103
  6-7 hours                    reference
  8-9 hours                0.90 [0.74,1.10]    0.3008
  10 hours and above       1.25 [0.77, 2.04]   0.3515
FEMALE ONLY (n = 2,455)
Sleep
  2 -5 hours               1.29 [0.94,1.77]    0.1132
  6-7 hours                    reference
  8-9 hours                0.96 [0.70, 1.31]   0.7730
  10 hours and above       1.14 [0.57, 2.29]   0.7085
MALE ONLY (n = 2,433)
Sleep
  2 -5 hours               1.40 [0.94, 2.08]   0.0977
  6-7 hours                    reference
  8-9 hours                0.84 [0.64,1.09]    0.1759
  10 hours and above       1.47 [0.71, 3.01]   0.2870

Hours of sleep were 2 to less than 5.5, 5.5 to less than 7.5, 7.5 to
less than 9.5, and 9.5 and above. !sup/?Adjusted for age (50 years to
less than 60, 60 and above), race/ethnicity (non/Hispanic White, non/
Hispanic Black, Mexican/American, and other), education (high school
graduate or less, more than High School), smoking (current, former,
and never), insurance (insured, not insured), self/perception of
health (excellent/very good, good, and fair/poor), and body mass index
(0 to less than 25, 25 to less than 30, and 30 and above).
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Title Annotation:Research Article
Author:Wiener, R. Constance; Shockey, Alcinda K. Trickett; Waters, Christopher
Publication:Sleep Disorders (Hindawi)
Date:Jan 1, 2018
Words:5793
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