Background & Aims

he growing interest in the relationship between Chronic Musculoskeletal Pain (CMP) and Sleep Disturbance (SD) underscores the need to understand their complex interplay [1-5]. SD is characterized by difficulty in initiating or maintaining sleep. CMP is a leading cause of disability and significantly impacts quality of life, with prevalence in the adult population.

In this study, using the UK Biobank dataset, we conducted a longitudinal analysis across multiple timepoints to investigate whether SD is linked to a higher likelihood of developing CMP as well as its role in the recovery from CMP.

Methods

The occurrence of CMP and sleep score at five different timepoints (TP 1-5) were extracted from the UK Biobank data. To determine whether SD increases the risk of CMP onset, we established a discovery and four replication cohorts. Participants were categorized into groups (no CMP onset/CMP onset) based on information gathered at subsequent timepoints. Likewise, we investigated if SD impacts the recovery from CMP (recovered/not recovered).

To test the hypothesis, both logistic and linear regression models were employed, incorporating control variables. In parallel, the analysis was replicated in participants diagnosed with CMP at baseline to determine the effect of sleep behaviors on their recovery. Additionally, for those with CMP onset, we examined the correlation between sleep score and the sites of CMP onset. The analysis was replicated in participants with a CMP condition at baseline, to assess the impact of the sleep behaviors on their recovery.

Results

Linear regression models showed significant differences between groups in the sleep score (p=0.0065) at TP 1 before the development of CMP in the discovery cohort with participants with CMP onset showing worse sleep behaviors. Differences were replicated across all the four replication cohorts for the sleep score (Replication 1: p=0.03, Replication2: p=0.02, Replication 3: p<0.001, Replication 4: p<0.001). Similarly, we found that the sleep score may also influence the recovery of chronic pain in 4 out of 5 datasets, with participants with persistent (not recovered) CMP showing worse sleep behaviors. Logistic Regression analysis showed that SD could increase the risk of CMP onset (p=0.03, odd ratio= 0.87). The findings were replicated in 3 out of 4 replication cohorts. Similarly, SD was found to be associated with increased risk of persistent CMP in 4 out of 5 cohorts. The sleep score was also significantly associated with the number of sites of CMP onset (p=0.003).

Conclusions

In the longitudinal analysis conducted on the UK Biobank datasets, we assessed the predictive value of sleep-related problems for CMP onset and its recovery. Our findings suggest that SD is associated with an increased risk of CMP onset and with the recovery from the CMP condition and multisite of pain.

References

[1] HODGES, S. et al. Associations among acute and chronic musculoskeletal pain, sleep duration, and C-reactive protein (CRP): A cross-sectional study of the UK biobank dataset. Sleep Medicine, 2023, 101: 393–400.

[2] KELLY, Gráinne A., et al. The association between chronic low back pain and sleep: a systematic review. The Clinical journal of pain, 2011, 27.2: 169-181.

[3] BAHOUQ, H., et al. Prevalence and severity of insomnia in chronic low back pain patients. Rheumatology international, 2013, 33: 1277-1281.

[4] UHLIG, Benjamin Langsæter, et al. Insomnia and risk of chronic musculoskeletal complaints: longitudinal data from the HUNT study, Norway. BMC musculoskeletal disorders, 2018, 19: 1-9.

[5] ARNISON, Tor, et al. Longitudinal, bidirectional relationships of insomnia symptoms and musculoskeletal pain across adolescence: The mediating role of mood. Pain, 2022, 163.2: 287-298.

Presenting Author

Mattia Cannistra

Poster Authors

Mattia Cannistra

MsC

MGH-Harvard Medical School

Lead Author

Valeria Sacca

MGH - Harvard Medical School

Lead Author

Liu Yu

MGH - Harvard Medical School

Lead Author

Pierangelo Veltri

University of Calabria

Lead Author

Tian Ge

MGH - Harvard Medical School

Lead Author

Topics

  • Models: Musculoskeletal