Background & Aims
Patients with chronic pain often report disrupted sleep. However, since most studies have focused on sleep in isolation or across a few measures (e.g., sleep quality, duration), these approaches may not account for other aspects of sleep disruption that co-occur in patients with chronic pain and differentially contribute to pain-related outcomes [1]. Using a multidimensional sleep health (MSH) framework that captures sleep across several domains (regularity, satisfaction, alertness, timing, efficiency, and duration) [2], we examined the association of individual sleep health dimensions and a composite sleep health score with pain, fatigue, and psychological functioning in young adults with chronic pain [3]. We hypothesized that better MSH would be associated with less pain, less fatigue, and better psychological functioning. We also investigated how sleep health differs across overlapping pain conditions (COPCs) [4].
Methods
Composite scores were based on the MSH model’s component dimensions, operationalized from actigraphy and self-report data. Individual MSH dimensions were dichotomized into “good” (assigned a score of 1) or “poor” (assigned a score of 0) using cut-offs from prior studies. Good sleep health derived from actigraphy-measured data included the standard deviation of sleep midpoint ?1-h (RU), mean of sleep midpoint 2:00-4:00 am (T), mean value of sleep efficiency ?85% (E), and mean total sleep time 7 to 9 hours (D). Good sleep health derived from self-report included the sleep quality item from the Pittsburgh Sleep Quality Index (PSQI) of ‘fairly’ or ‘very’ good (S) and alertness based on the PROMIS Sleep-Related Impairment ? 50 (A). Scores were summed across all domains to obtain a composite MSH score ranging from 0 to 6, with higher scores indicating better MSH. Univariate models examined the association of sleep dimensions and composite MSH score with pain and fatigue, and COPCs.
Results
Thirty-nine adults (ages 18-34, Mean age=27.1, 92.3% female) with COPCs provided baseline data on fatigue (PROMIS), pain (Pain, Enjoyment and General Activity [PEG] Scale), and number of COPCs (COPC Screener). The following observations were found in this study. (i) The mean MSH score was 2.41 ± 1.48, and sleep quality (S), alertness (A), and timing (T) domains were most rated as poor (64.1%, 94.9% and 66.7%, respectively), with most patients having four or more domains rated as poor (53.8%). (ii) Higher PEG scores (r =-0.35, p = 0.03), fatigue (r =-0.39, p = 0.01), and a higher number of COPC s (r = -0.36, p = 0.02) were associate with lower MSH scores. (ii) Several individual sleep dimensions, including lower alertness and poor sleep quality, were related to greater fatigue (A: t = 3.15, p = 0.01; S: t = 2.21, p = 0.03) and greater number of pain conditions COPC (A: t = 2.21, p = 0.03; S: t = 2.57, p = 0.02).
Conclusions
These data indicate better multidimensional sleep health (MSH) is associated with lower pain-related outcomes in young adults with COPCs. Also, poorer sleep health in this cohort was characterized by low subjective satisfaction, inappropriate timing, and impaired alertness during waking hours, suggesting that these dimensions could be targeted for intervention. In agreement with previous literature, this study indicates that assessing sleep as a multidimensional construct across several objective (i.e., duration, efficiency, timing, regularity) and subjective (i.e., daytime alertness, sleep satisfaction) domains may better reflect the complex neurobiological mechanisms, rather than focusing on a few domains, underlying sleep disruption in patients with chronic pain.
References
[1] Yoo A, Vgontzas A, Chung J, Mostofsky E, Li W, Rueschman M, et al. The association between multidimensional sleep health and migraine burden among patients with episodic migraine. J Clin Sleep Med. 2023;19(2):309-17. doi: 10.5664/jcsm.10320.
[2] Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014;37(1):9-17. doi: 10.5665/sleep.3298.
[3] Boggero IA, Sangalli L, Brasch L, King CD. Social health in young women with chronic pain. Pain Rep. 2024;9(2):e1146. doi: 10.1097/PR9.0000000000001146.
[4] Sanders AE, Greenspan JD, Fillingim RB, Rathnayaka N, Ohrbach R, Slade GD. Associations of Sleep Disturbance, Atopy, and Other Health Measures with Chronic Overlapping Pain Conditions. J Oral Facial Pain Headache. 2020;34(Suppl):s73-s84. doi: 10.11607/ofph.2577.
Presenting Author
Ian Boggero
Poster Authors
Christopher King
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, US
Lead Author
M. Clara Hartman
BS
Cincinnati Children’s Hospital Medical Center
Lead Author
Hanh Trang Do
BS
Cincinnati Children’s Hospital Medical Center
Lead Author
Carley Conway
University of Kentucky
Lead Author
Ian Boggero
University of Kentucky College of Dentistry
Lead Author
Topics
- Lifestyle Issues: Sleep/Diet/Exercise/Social Interactions