Impact of Insomnia Treatment on Systemic Inflammation in Patients With Knee Osteoarthritis: A Critically Appraised Topic

<strong>Clinical Scenario:</strong> Individuals with knee osteoarthritis (OA) frequently experience difficulty sleeping, and insomnia in this population has been associated with elevated levels of systemic inflammation. Cognitive behavioral therapy designed to treat insomnia is a nonpharmacological intervention that may reduce inflammation by improving sleep quality. <strong>Clinical Question:</strong> In patients with comorbid knee OA and insomnia, does implementation of Cognitive Behavioral Therapy for Insomnia (CBT-I), compared to control interventions, reduce systemic inflammation as measured by blood biomarker concentrations? <strong>Summary of Key Findings:</strong> Two randomized controlled trials were included. The two identified studies assessed the impact of CBT-I on inflammatory markers among adults with knee OA and insomnia disorder. Both studies measured inflammation using blood biomarker concentrations to evaluate systemic inflammation. Although neither study found that CBT-I significantly reduced systemic inflammation overall, both reported improvements in sleep and pain-related outcomes, suggesting that the intervention may offer clinical benefits even in the absence of measurable changes in inflammation. <strong>Clinical Bottom Line:</strong> There is currently inconsistent, limited-quality, patient-oriented evidence that does not support the use of CBT-I to reduce systemic inflammation in patients with knee OA and insomnia compared with the standard of care group. Future research should explore the long-term effects of CBT-I on systemic inflammation and pain outcomes in individuals with comorbid knee OA and insomnia to strengthen clinical applicability. <strong>Strength of Recommendation:</strong> The grade of B is recommended by the Strength of Recommendation Taxonomy for inconsistent, limited-quality, patient-oriented evidence.