New-onset obstructive sleep apnea and insomnia after total knee replacement in patients with osteoarthritis: real-world evidences.

BACKGROUND

Total knee replacement (TKR) is the primary treatment for advanced osteoarthritis, but its impact on postoperative sleep disorders remains unclear. This study investigates the association between TKR and new-onset obstructive sleep apnea (OSA) and insomnia.

METHOD: A retrospective cohort study was conducted using the TriNetX US Collaborative Network. Adults (⩾18 years) diagnosed with osteoarthritis who underwent TKR were propensity-matched 1:1 to non-TKR controls based on demographics, comorbidities, and medication use. The primary outcomes were new-onset OSA and insomnia, assessed using Cox proportional hazard models with hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity and stratification analyses were performed to validate findings.

RESULTS

TKR patients had a significantly higher risk of OSA (HR: 1.71, 95% CI: 1.50-1.95 at 1 year; HR: 1.36, 95% CI: 1.28-1.44 at 5 years) and insomnia (HR: 1.55, 95% CI: 1.32-1.82 at 1 year; HR: 1.22, 95% CI: 1.13-1.31 at 5 years). Sensitivity analyses confirmed robustness across different propensity-matching methods and washout periods. Stratification showed higher risks in older adults (⩾65 years: HR: 1.40 for OSA, 1.32 for insomnia) and females (HR: 1.49 for OSA, 1.27 for insomnia).

CONCLUSION

TKR increases the long-term risk of OSA and insomnia, particularly in older and female patients. Clinicians were recommended to monitor postoperative sleep health to improve recovery outcomes.