{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:44:24Z","timestamp":1777877064077,"version":"3.51.4"},"reference-count":41,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100004699","name":"Chung Shan Medical University Hospital","doi-asserted-by":"crossref","award":["CSH-2025-A-007"],"award-info":[{"award-number":["CSH-2025-A-007"]}],"id":[{"id":"10.13039\/501100004699","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Musculoskeletal"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted using the TriNetX US Collaborative Network. Adults (\u2a7e18\u2009years) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>TKR patients had a significantly higher risk of OSA (HR: 1.71, 95% CI: 1.50\u20131.95 at 1\u2009year; HR: 1.36, 95% CI: 1.28\u20131.44 at 5\u2009years) and insomnia (HR: 1.55, 95% CI: 1.32\u20131.82 at 1\u2009year; HR: 1.22, 95% CI: 1.13\u20131.31 at 5\u2009years). Sensitivity analyses confirmed robustness across different propensity-matching methods and washout periods. Stratification showed higher risks in older adults (\u2a7e65\u2009years: HR: 1.40 for OSA, 1.32 for insomnia) and females (HR: 1.49 for OSA, 1.27 for insomnia).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1759720x251384581","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:18:45Z","timestamp":1761045525000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["New-onset obstructive sleep apnea and insomnia after total knee replacement in patients with osteoarthritis: real-world evidences"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8897-5635","authenticated-orcid":false,"given":"Shuo-Yan","family":"Gau","sequence":"first","affiliation":[{"name":"Department and Graduate Institute of Business Administration, National Taiwan University, Taipei, Taiwan"},{"name":"Orthopedics Department, Chi-Mei Medical Center, Tainan, Taiwan"},{"name":"Evidence-Based Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan"},{"name":"Institute of Allergology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiang-En","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui-Chin","family":"Chang","sequence":"additional","affiliation":[{"name":"Evidence-Based Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan"},{"name":"Library, Chung Shan Medical University Hospital, Taichung, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Lung","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine, Chung Shan Medical University, Taichung, Taiwan"},{"name":"Department of Orthopedic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiu-Jau","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. 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