Skip to main content
Download PDF

Sleep quality and nocturnal pain in patients with femoroacetabular impingement and acetabular dysplasia

BMC Musculoskeletal Disorders volume 21, Article number: 134 (2020) Cite this article

Abstract

Background

Femoroacetabular impingement (FAI) syndrome and acetabular dysplasia (AD) are common pathologies that lead to pain in the young adult hip. Nocturnal pain in these patients is often reported, yet little is known regarding the effect of these hip pathologies on overall sleep quality. The purpose of this study was to evaluate sleep quality in patients with AD and FAI syndrome.

Methods

This cross-sectional study consisted of 115 patients who complained of hip pain secondary to either FAI syndrome or AD. One hundred fifteen patients with hip pain secondary to FAI syndrome and AD were assessed using the Hip Outcome Score (HOS), Modified Harris Hip Score (mHHS), and then Hip disability and Osteoarthritis Outcome Score (HOOS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression, with adaptive LASSO variable selection, was used to assess factors associated with sleep quality.

Results

Of the 115 patients, 62 had a diagnosis of FAI syndrome and 53 with AD. The mean age was 34.55 ± 11.66 (age range: 14 to 58 years), 76.52% had an ASA classification of 1 (ASA range: 1 to 3), and all Tonnis grades were either 0 or 1. The mean PSQI global score for all patients was 8.46 ± 4.35 (PSQI range: 0 to 21), indicating poor sleep quality. The adaptive LASSO-penalized least squares multiple linear regression revealed that HOOS Pain, SF-12 Role Emotional, and SF-12 Mental Health significantly predicted Sleep Quality (Adjusted R2 = 0.4041). Sleep quality improved as pain, emotional problems, and mental health improved.

Conclusion

Patients with symptomatic FAI syndrome and AD have poor sleep quality. Worsening pain from a patient’s hip pathology is associated with poor sleep, even prior to the onset of osteoarthrosis of the hip. Patients presenting with hip pain from FAI syndrome and AD should be screened for sleep disturbance and may benefit from a multidisciplinary treatment approach.

Peer Review reports

Background

Femoroacetabular impingement (FAI) syndrome is characterized by abnormal contact forces of the hip with an incidence of the cam morphology predicted to be approximately 14–68% of the general population based on the inclusion criteria, and there is a predominance of young, athletic patients affected [1,2,3,4,5,6]. The presence of FAI syndrome has been hypothesized to contribute to hip degeneration and future osteoarthritis [7]. Acetabular dysplasia (AD) is a condition in which the acetabulum is shallow and does not provide sufficient coverage of the femoral head [8]. There is an estimated prevalence of 0.1% in the adult population, and it is a known precursor to osteoarthritis, with evidence of acetabular dysplasia in 20–40% of patients with osteoarthritis of the hip [9,10,11]. Both hip pathologies are associated with hip pain, decreased quality of life, and morbidity in an often-young active population [12, 13]. Nocturnal pain and poor sleep are often reported, but little is known on the variables that predict sleep disturbance in these patients.

Nocturnal pain has been shown to affect sleep quality, although there is limited evidence of such effects in FAI syndrome and AD. Effects of other musculoskeletal pathologies on sleep quality have been thoroughly studied. A recent study conducted by Khazzam et al. has shown a significant relationship between sleep disturbance and shoulder pain [14]. A study conducted by Tang et al. showed 53% of patients with chronic back pain reported sleep disturbances consistent with clinical insomnia [15]. Decreases in sleep quality have been linked to overall decreases in quality of life, increases in rates of depression and anxiety, and many metabolic disturbances such as diabetes and obesity [16,17,18]. Long-term impacts of poor sleep quality have shown to have a particularly negative outcome in young, healthy patients [16]. Given the prevalence of these two hip diagnoses in the young adult population, sleep is an especially important factor to be considered because of the significant impact on health and quality of life.

The purpose of this study was to assess how hip pain from FAI syndrome and AD, as well as other patient factors, in a young adult population with symptomatic hip pain affect self-reported sleep quality. We hypothesize that patients with symptomatic FAI syndrome and AD are susceptible to poor sleep quality.

Methods

Participants

We prospectively evaluated 115 patients presenting to a comprehensive orthopedic hip clinic in Dallas, USA with a chief complaint of hip pain, and who were diagnosed with either FAI syndrome (n = 62) or AD (n = 53), at a single academic medical center between November 2016 and May 2017. Diagnoses were made by clinical and radiologic evaluation by the treating orthopaedic surgeon. FAI syndrome was diagnosed by clinical and radiographic evaluation [19]. Diagnosis of FAI syndrome was based on evidence of restricted range of motion and anterior impingement test in patients with radiographic evidence of alpha angle greater than 55 or lateral center edge angle greater than 38 [1, 11, 20,21,22]. Patients that presented with hip pain and radiographic evidence of femoral head uncovering and a lateral center-edge angle less than 20 degrees were diagnosed with symptomatic AD [23,24,25,26,27,28]. Patients with concurrent diagnoses, such as hip osteoarthritis or previous hip surgeries, were excluded from the study. A total of 106 patients were excluded on the basis of an osteoarthritis diagnosis. All patients included in the study were pre-treatment and pre-surgical patients treated by the senior author, fellowship trained in hip preservation.

All 115 patients voluntarily completed a comprehensive set of IRB-approved questionnaires that assessed hip function, sleep quality, pain, and overall health. The sample size established was a convenience sample consisting of patients presenting to the clinic with the diagnoses in question. In particular, patients completed questionnaires that included the Hip disability and Osteoarthritis Outcome Score (HOOS), Hip Outcome Score (HOS) scale, Modified Harris Hip Score (mHHS) scale, UCLA Activity scale, International Hip Outcome Tool (iHOT), Visual Analogue Pain Scale (EQ-VAS), Short Form Health Survey (SF-12), and the Pittsburgh Sleep Quality Index (PSQI) [29,30,31,32,33,34,35,36].

Outcome measure

The primary outcome measure was sleep quality. Sleep quality was measured using the total score on the Pittsburgh Sleep Quality Index (PSQI) Scale [29]. The PSQI is a standardized measure of sleep quality. It consists of 19 self-reported questions regarding various aspects of sleep quality during the previous month from the time of assessment [29]. The final scores of the PSQI consist of seven component scores, with each component scored 0 (no sleep difficulty) to 3 (severe sleep difficulty). The seven PSQI component scores were summed to produce a total, or global, score that ranged from 0 to 21. Higher PSQI Total (global) Scores indicate worse sleep quality [29].

Potential predictor variables

An initial pool of 39 characteristic variables was selected for analysis as potential predictors of Sleep Quality. The pool of potential predictors, which was selected a priori, included: Diagnosis group (FAI syndrome vs. AD), sex, age (years), BMI (kg/m2), ASA physical status classification system (ASA 1 ̶ ASA 4), Tonnis grade (grades 0–3), EQ-VAS (overall health state), patient function level (scored 0–100%, higher score indicated greater normal function level), International Hip Outcome Tool (iHOT) total score (measure of quality of life), Modified Harris Hip score (left and right hip), Hip outcome subscale scores (activity of daily living, sports), UCLA activity score, VAS pain level (averaged score), SF-12 subscale scores (general health, physical functioning, role functioning, bodily pain, vitality, role emotional, mental health, and social functioning; each of the SF12 subscales was scored so that a higher score indicated greater functioning), HOOS subscale scores (pain, symptoms, sports and recreational, quality of life, and activity of daily living). Each HOOS subscale score ranged from 0 to 100 and was scored so that a higher score indicated greater functioning. The following comorbidities were also assessed (yes/no) and included as potential predictors: current smoking status, heart disease, high blood pressure, lung disease, diabetes, ulcer or stomach disease, kidney disease, depression, obstructive sleep apnea, liver disease, and low back pain. Each of the potential predictors was patient self-reported and measured during the patients’ most recent orthopaedic clinic visit.

Statistical analysis

Demographic and clinical characteristics for the sample of 115 patients were described using the sample mean and standard deviation for continuous variables and the frequency and percentage for categorical variables. To identify differences on these characteristics between those diagnosed with FAI syndrome vs. AD, we implemented the two-independent sample t-test with the Satterthwaite method for unequal variances (for continuous variables) and Fisher’s exact test (for categorical variables).

Next, to utilize the maximum potential of the data, we followed the recommendations of Shomaker et al. and carried out both multiple imputation of missing data and the bootstrap [37]. Starting with the initial pool of 39 variables, a filtering process was used to identify a subset of variables that seemed to contain predictive power. The process was implemented using the adaptive LASSO-penalized variable selection method, with the Shwarz Bayesian information criterion, in the context of a multiple linear regression model for the outcome of sleep quality that was based on 10,000 bootstrap samples [38]. The goal of the adaptive LASSO-penalized linear regression was to select a parsimonious and well-fitting subset of potential predictors of sleep quality by performing simultaneous variable selection and parameter estimation. This is done by optimizing a penalized least squares criterion that expresses a balance between good fit and parsimony. Finally, the one-way ANCOVA was used to compare the two diagnosis groups (FAI syndrome vs. AD) on the measure of sleep quality, while controlling for age, sex, as well as the predictors that emerged from the adaptive LASSO-penalized regression. Least squares means (LSM) was estimated as part of the ANCOVA model. Cohen’s d was calculated to estimate the effect size for the between-subjects group effect.

Statistical analyses were carried out using SAS software, version 9.4 (SAS Institute, Inc., Cary, NC, USA). The level of significance was set at α = 0.05 (two-tailed) and we implemented the False Discovery Rate (FDR) procedure, where applicable, to control false positives over the multiple tests.

Results

Participant characteristics

Of the total sample of 115 patients, 70.43% were female, the mean age was 34.55 ± 11.66 years (age range = 14 to 58 years), 54% had a diagnosis of FAI syndrome (n = 62), and 46% had a diagnosis of AD (n = 53). Eighty-nine percent of the patients with a diagnosis of AD and 79% of FAI syndrome reported poor sleep quality (mean PSQI total: 9.00 ± 4.37 and 8.00 ± 4.32). The mean PSQI score of all patients was 8.46 ± 4.35, indicating an average poor sleep quality of the overall patients in the study. Mean scores for HOOS Pain, SF12 Role Emotional, and SF12 Mental Health were 64.02 ± 19.02, 47.37 ± 12.17, and 43.02 ± 11.68, respectively. Demographic and clinical characteristics of the patient cohort are shown in Table 1.

Table 1 Demographic and clinical characteristics of the overall sample and by hip diagnosis
Full size table

Orthopedic diagnosis and sleep quality

The one-way ANCOVA revealed no significant diagnosis group (FAI syndrome vs. AD) main effect on sleep quality (F = 0.01; df = 1108; p = 0.9315), while controlling for age, sex, HOOS Pain, SF12 role emotional, and SF12 mental health. Although the pattern of the adjusted least squares means (LSM) revealed that PSQI Total (global) scores were not significantly different between the FAI and AD diagnosis groups (FAI LSM = 8.4891, SE = 0.4562 vs. AD LSM = 8.4278, SE = 0.4978; Cohen’s d = 0.0162), both diagnosis groups had global LSM PSQI scores above 5, indicating poor sleep quality.

Predictors of Sleep Quality

The subset of predictor variables that were selected from the multiple linear regression, with adaptive LASSO variable selection, for the outcome of sleep quality is reported in Table 2 and Fig. 1.

Table 2 Multiple Linear Regression Model for Predictors of Sleep Quality using an Adaptive LASSO-penalized variable selection method
Full size table
Fig. 1
figure 1

Plot of PSQI Total Score against the selected predictor variables, with a fitted linear regression line and 95% confidence limits. Observed sample, N = 115

Full size image

We reported the averaged LASSO-penalized parameter estimates and standard deviation that were based on 10,000 bootstrap samples of the multiple linear regression models along with the 95% bootstrap confidence interval. For the 95% CI that did not contain zero, the respective mean parameter estimate was statistically significant at alpha = 0.05 (two-tailed). As shown in Table 2, the adaptive LASSO-penalized least squares multiple linear regression revealed that HOOS Pain, SF12 Role Emotional, and SF12 Mental Health significantly predicted Sleep Quality (Adjusted R2 = 0.4041). Sleep quality improved as pain, role emotional, and mental health improved. Of the selected predictor variables from the adaptive LASSO-penalized multiple linear regression model (Table 2), the standardized parameter estimates revealed that HOOS Pain can be interpreted as having a greater magnitude of relative importance in the expected relationship with Sleep Quality (standardized beta = − 0.3609).

Discussion

The findings of this study showed 83% of patients presenting with FAI syndrome and AD reported poor sleep quality. Significant predictors of sleep quality in our patient cohort included the HOOS pain, SF-12 survey role limitations due to emotional problems, and SF-12 survey mental health problems. Indeed, we found that sleep quality was better with less pain, role emotional, and mental health scores. The HOOS Pain had the greatest magnitude of importance when predicting sleep quality. Given that a PSQI score of 5 or greater indicates poor sleep quality, the average score of 8.46 in our cohort shows a marked decline in sleep quality compared to the general population. Although we found no significant difference in sleep quality when comparing FAI syndrome to AD, both diagnosis groups had global PSQI scores above 5, indicating poor overall sleep quality. We investigated several potential confounding variables to isolate the patient’s hip pain as the true reason for sleep disturbance, and the variables remained independent predictors of sleep. This supports symptomatic FAI syndrome and AD as major factors in determining sleep quality.

The effects of other musculoskeletal pathologies on sleep quality have been thoroughly studied. Previous research has shown that patients with disorders such as osteoarthritis and chronic low back pain suffer from considerably reduced sleep quality [39, 40]. Rhon et al. described in a 2018 study that the incidence of sleep disorders rose significantly following elective hip arthroscopy when compared to preoperative sleep status [41]. This comorbidity is often overlooked as a risk of hip intervention. However, a study by Gong et al. showed that clinical interventions targeting sleep have shown to improve quality of life and patient satisfaction following total knee arthroplasty [42]. We have now shown that hip pain secondary to FAI syndrome and AD also causes sleep disturbance. Sleep quality is a potential area of improvement in patient outcomes in FAI syndrome and AD.

Few studies have looked at the association of pain caused by FAI syndrome and AD with that of poor sleep [43, 44]. A 2017 study by Prather et al. showed significant disorders of sleep in young and middle-aged patients with hip pain [44]. While their findings support our work, Prather et al. did not employ validated hip outcome scales to quantify the effect of patient-reported symptoms due to hip pathology. To our knowledge, the current study is the first to utilize validated patient questionnaires to determine predictors of sleep quality in patients with FAI syndrome and AD. In our patient population with FAI syndrome and AD, even though young with minimal comorbidities, sleep disturbance is found to a great degree.

The validated patient reported outcome measures used in the current study to measure hip function, sleep quality, pain, and overall health are easy to administer in an outpatient setting and should be utilized to screen for sleep quality. They can be used to routinely to evaluate change in sleep quality in order to assess deficits before possible detrimental effects. This has significant implications for a patient’s mental and emotional health, quality of life, and overall wellness, and is particularly important in our patient cohort given it consists mainly of young, healthy patients. Young patients are at risk for long-term morbidity as a consequence of decreased sleep quality. Addressing the problem of nocturnal pain causing poor sleep may reduce the risk of impairment. Orthopaedic physicians should spend time assessing patients’ sleep quality as well as counseling them on possible adverse effects of hip pain on sleep [45]. A study conducted by Kunze et al. in 2019 showed an improvement in sleep quality following hip arthroscopy for patients with FAI syndrome [43]. In patients who are not ideal candidates for this treatment, other treatments specifically for sleep disturbance to be considered include education on sleep hygiene, ideal positioning, and sleep medicinal aids.

Limitations in this study include the subjective nature of self-reported patient questionnaires. This could have led to inconsistencies in reporting among individual patients. In addition, the lack of standardized variables within the study such as polysomnography and other sleep studies furthers the subjective nature of the data presented here. However, given the subjective nature of pain and sleep quality, it is arguably more clinically significant to obtain self-reported measures in regard to overall wellness. Another limitation in this study is the lack of data reporting the patient cohort’s sleep quality prior to the diagnosis of FAI syndrome or DDH. Additionally, these patients were not compared with age-matched controls, although historically this cohort, consisting of young patients with minimal comorbidities, is found to have less pathologic sleep [46]. All patients in the study came from one orthopedic specialty clinic, so results may not generalize to the all orthopedic patients with varying diagnoses of pain. Further important areas of study would be to follow patients with sleep disturbance throughout their treatment and assess sleep quality changes over time.

Conclusion

In conclusion, we found that patients with hip pain from that of FAI syndrome and AD are susceptible to poor sleep quality. We also found that sleep quality was better with higher scores indicating lower pain, fewer role limitations due to emotional problems, and improved mental health. Patients presenting with hip pain from FAI syndrome and AD should be screened for sleep disturbance and may benefit from a multidisciplinary treatment approach. Future research should look into treatment of these specific hip pathologies and its effect on sleep quality. It is important to note whether treatment of FAI syndrome and AD has an effect on self-reported sleep quality using the same measurement tool as this study. Different modes of management for each condition can be compared to assess which option is better suited to improve overall sleep quality.

Availability of data and materials

The data generated for this study is not publicly available in order to protect patient privacy. The corresponding author may provide this information on reasonable request.

Abbreviations

AD:

Acetabular dysplasia

EQ-VAS:

Visual Analogue Pain Scale

FAI:

Femoroacetabular impingement

HOOS:

Hip disability and Osteoarthritis Outcome Scor

HOS:

Hip Outcome Score

iHOT:

International Hip Outcome Tool

mHHS:

Modified Harris Hip Score

PSQI:

Pittsburgh Sleep Quality Index

SF-12:

Short Form Health Survey

References

  1. Anderson LA, Anderson MB, Kapron A, et al. The 2015 frank Stinchfield award: radiographic abnormalities common in senior athletes with well-functioning hips but not associated with osteoarthritis. Clin Orthop Relat Res. 2015;474(2):342–52.

    Article  PubMed Central  Google Scholar 

  2. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. Bone Joint Surg Br. 2005;87-B(7):1012–8.

    Article  Google Scholar 

  3. Dickenson E, Wall PD, Robinson B, et al. Prevalence of cam hip shape morphology: a systematic review. Osteoarthr Cartil. 2016;24:949–61.

    Article  CAS  Google Scholar 

  4. Griffin DR, Dickenson EJ, O'Donnell J, et al. The Warwick agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50:1169–76.

    Article  CAS  PubMed  Google Scholar 

  5. Nepple JJ, Vigdorchik JM, Clohisy JC. What is the association between sports participation and the development of proximal femoral cam deformity? A systematic review and meta-analysis. Am J Sports Med. 2015;43:2833–40.

    Article  PubMed  Google Scholar 

  6. Röling MA, Mathijssen NMC, Bloem RM. Incidence of symptomatic femoroacetabular impingement in the general population: a prospective registration study. J Hip Preservation Surg. 2016;3(3):203–7.

    Article  Google Scholar 

  7. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.

    Google Scholar 

  8. Henak CR, Abraham CL, Anderson AE, Maas SA, Ellis BJ, Peters CL, et al. Patient specific analysis of cartilage and labrum mechanics in human hips with acetabular dysplasia. Osteoarthr Cartil. 2014;22:210–7.

    Article  CAS  Google Scholar 

  9. Gala L, Clohisy JC, Beaule PE. Hip dysplasia in the young adult. J Bone Surg. 2016;98-A:63–73.

    Article  Google Scholar 

  10. Matsuda DK, Wolff AB, Nho SJ, Salvo JP Jr, Christoforetti JJ, Kivlan BR, Ellis TJ. Carreira DS; multicenter arthroscopic study of the hip (MASH) study group. Hip dysplasia: prevalence, associated findings, and procedures from large multicenter arthroscopy study group. Arthroscopy. 2018;34(2):444–53.

    Article  PubMed  Google Scholar 

  11. Wyles CC, Heidenreich MJ, Jeng J, Larson DR, Trousdale RT, Sierra RJ. The John Charnley award: redefining the natural history of osteoarthritis in patients with hip dysplasia and impingement. Clin Orthop Relat Res. 2016;475(2):336–50. https://doi.org/10.1007/s11999-016-4815-2.

    Article  PubMed Central  Google Scholar 

  12. Gambling TS, Long A. Psycho-social impact of developmental dysplasia of the hip and of differential access to early diagnosis and treatment: a narrative study of young adults. SAGE Open Med. 2019;7:2050312119836010.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sheean AJ, Schmitz MR, Ward CL, et al. Assessment of disability related to femoroacetabular impingement syndrome by use of the patient-reported outcome measure information system (PROMIS) and objective measures of physical performance. Am J Sports Med. 2017;45(11):2476–82.

    Article  PubMed  Google Scholar 

  14. Khazzam MS, Mulligan EP, Brunette-Christiansen M, Shirley Z. Sleep Quality in Patients with Rotator Cuff Disease. J Am Acad Orthop Surg. 2018;26(6):215–22.

    Article  PubMed  Google Scholar 

  15. Tang NK, Wright KJ, Salkovskis PM. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res. 2007;16:85–95.

    Article  PubMed  Google Scholar 

  16. Augnet C. Associations of subjective sleep quality with depression score, anxiety, physical symptoms and sleep onset latency in young students. Cent Eur J Public Health. 2011;19(2):115–7.

    Article  Google Scholar 

  17. Broussard JL, Van Cauter E. Disturbances of sleep and circadian rhythms: novel risk factors for obesity. Curr Opin Endocrinol Diabetes Obes. 2016;23:353–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Guyon A, Morselli LL, Balbo ML, et al. Effects of insufficient sleep on pituitary-adrenocortical response to CRH stimulation in healthy men. Sleep. 2017;40:6.

    Article  Google Scholar 

  19. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467(3):638–44.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cheatham SW, Enseki KR, Kolber MJ. The clinical presentation of individuals with femoral acetabular impingement and labral tears: a narrative review of the evidence. J Bodyw Mov Ther. 2016;20:346–55.

    Article  PubMed  Google Scholar 

  21. Gosvig KK, Jacobsen S, Sonne-Holm S, Palm H, Troelsen A. Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am. 2010;92:1162–9.

    Article  PubMed  Google Scholar 

  22. Larson CM, Moreau-Gaudry A, Kelly BT, Byrd JW, Tonetti J, Lavallee S, Chabanas L, Barrier G, Bedi A. Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage. Clin Orthop Relat Res. 2015;473:1247.

    Article  PubMed  Google Scholar 

  23. Clohisy JC, Beaule PE, O’Malley A, et al. AOA symposium: hip disease in the young adult: current concepts of etiology and surgical treatment. J Bone Joint Surg Am. 2008;90(10):2267–81.

    Article  PubMed  Google Scholar 

  24. Clohisy JC, Keeney JA, Schoenecker PL. Preliminary assessment and treatment guidelines for hip disorders in young adults. Clin Orthop Relat Res. 2005;441:168–79.

    Article  PubMed  Google Scholar 

  25. Tonnis D, Heinecke A. Current concepts review: acetabular and femoral anteversion. Relationship with osteoarthritis of the hip. J Bone Surg Am. 1999;81:1747–70.

    Article  CAS  PubMed  Google Scholar 

  26. Wells J, Millis M, Kim YJ, et al. Survivorship of the Bernese periacetabular osteotomy: what factors are associated with long-term failure? Clin Orthop Relat Res. 2017;475:396–405.

    Article  PubMed  Google Scholar 

  27. Wells J, Nepple JJ, Crook K, Ross JR, Bedi A, Schoenecker P, Clohisy JC. Femoral morphology in the dysplastic hip: Three-dimensional characterizations with CT. Clin Orthop Relat Res. 2017;475(4):1045–54.

    Article  PubMed  Google Scholar 

  28. Wells J, Schoenecker P, Duncan S, et al. Intermediate-term hip survivorship and patient-reported outcomes of periacetabular osteotomy: the Washington University experience. J Bone Joint Surg Am. 2018;100:218–25.

    Article  PubMed  Google Scholar 

  29. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index (PSQI): a new instrument for psychiatric research and practice. Psychiatry Res. 1989;28(2):193–213.

    Article  CAS  PubMed  Google Scholar 

  30. EuroQol Group. EuroQol- a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–203.

    Article  Google Scholar 

  31. Mahomed NN, Arndt DC, McGrory BJ, Harris WH. The Harris hip score: comparison of patient self-report with surgeon assessment. J Arthroplast. 2001;16(5):575–80.

    Article  CAS  Google Scholar 

  32. Martin RL, Philippon MJ. Evidence of validity for the hip outcome score in hip arthroscopy. Arthroscopy. 2007;23(8):822–6.

    Article  PubMed  Google Scholar 

  33. Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM. Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003;4:10.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ruiz-Ibán MA, Seijas R, Sallent A, et al. The international Hip Outcome Tool-33 (iHOT-33): multicenter validation and translation to Spanish. Health Qual Life Outcomes. 2015;13:62.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ware J, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.

    Article  PubMed  Google Scholar 

  36. Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplast. 1998;13:890–5.

    Article  CAS  Google Scholar 

  37. Schomaker M, Heumann C. Model selection and model averaging after multiple imputation. Comput Stat Data Anal. 2014;77:758–70.

    Article  Google Scholar 

  38. Zou H. The adaptive Lasso and its oracle properties. J Am Stat Assoc. 2006;101:1418–29.

    Article  CAS  Google Scholar 

  39. Allen KD, Renner JB, Devellis B, et al. Osteoarthritis and sleep: the Johnston County osteoarthritis project. J Rheumatol. 2008;35:1102–7.

    PubMed  PubMed Central  Google Scholar 

  40. Marin R, Cyhan T, Miklos W. Sleep disturbance in patients with chronic low back pain. Am J Phys Med Rehabil. 2006;85(5):430–5.

    Article  PubMed  Google Scholar 

  41. Rhon DI, Greenlee TA, Marchant BG, et al. Comorbidities in the first 2 years after arthroscopic hip surgery: substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions. Br J Sports Med. 2019;53:547–53.

    Article  PubMed  Google Scholar 

  42. Gong L, Wang Z, Fan D. Sleep quality effects recovery after total knee arthroplasty (TKA)-a randomized, double-blind, controlled study. J Arthroplast. 2015;30(11):1897–901.

    Article  Google Scholar 

  43. Kunze KN, Leong NL, Beck EC, Bush-Joseph CA, Nho SJ. Hip arthroscopy for Femoroacetabular impingement improves sleep quality postoperatively. Arthroscopy. 2019;35(2):461–9.

    Article  PubMed  Google Scholar 

  44. Prather H, Creighton A, Sorenson C, Simpson S, Reese M, Hunt D, Rho M. Anxiety and insomnia in young and middle-aged adult hip pain patients with and without Femoroacetabular impingement and developmental hip dysplasia. PM R. 2018;10(5):455–61.

    Article  PubMed  Google Scholar 

  45. Bourdillon F. Tézenas du Montcel S, Collin E, Coutaux a, Lébeaupin E, Cesselin F, bourgeois P. determinants of patient satisfaction regarding pain care. Rev Epidemiol Sante Publique. 2012;60(6):455–62.

    Article  CAS  PubMed  Google Scholar 

  46. Miner B, Kryger MH. Sleep in the aging population. Sleep Med Clin. 2017;12(1):31–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

N/A.

Funding

Hoglund Foundation.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd 1st floor, Dallas, TX, 75390, USA

    Nisha Reddy, J. Riley Martinez, Edward Mulligan, Paul Nakonezny & Joel Wells

  2. Department of Population and Data Sciences (Division of Biostatistics), University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA

    Paul Nakonezny

Authors
  1. Nisha Reddy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Riley Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edward Mulligan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul Nakonezny
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joel Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NR is a major contributor to the writing of the manuscript. She was involved in the data collection and analysis as well. JRM assisted in the writing of the manuscript and data collection. EM served as the physical therapist for patients in this study and contributed to the writing of the manuscript. PN served as the primary statistician and contributed through data analysis and writing. JW is the primary orthopaedic surgeon who conceived the idea for this study and personally cared for all of the patients enrolled. All authors approved of the final manuscript prior to submission.

Authors’ information

Dr. Joel Wells is an assistant professor at the UT Southwestern Medical Center Department of Orthopaedic Surgery. He completed residency at the Harvard combined program, then going on to receive advanced training in joint preservation, resurfacing, and reconstructive surgery through a fellowship at Washington University in St. Louis. He now tends to the Dallas population with an emphasis on hip symptomatology and preservation in patients of all ages.

Corresponding author

Correspondence to Joel Wells.

Ethics declarations

Ethics approval and consent to participate

IRB approved research study STU 122016–058 at UT Southwestern Medical Center, all patients gave written consent to participate.

Consent for publication

N/A.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Reddy, N., Martinez, J.R., Mulligan, E. et al. Sleep quality and nocturnal pain in patients with femoroacetabular impingement and acetabular dysplasia. BMC Musculoskelet Disord 21, 134 (2020). https://doi.org/10.1186/s12891-020-3151-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12891-020-3151-6

Keywords

  • Pittsburgh sleep quality index
  • Sleep quality
  • Hip dysplasia
  • Femoroacetabular impingement syndrome

BMC Musculoskeletal Disorders

ISSN: 1471-2474

Contact us