Background & Aims

The relationship between sleep and the incidence of pain outcomes appears to be consistent but not completely understood, especially at population levels. High-impact chronic pain (HICP) is a relevant pain outcome since it accounts for the greatest individual and population burden of chronic pain. The aim of the present study was to assess if “sleep troubles” and “fatigue symptoms” at baseline contributed to the incidence of HICP at 1-year follow-up in a population-based cohort study of United States (US) adults.

Methods

We used data from the 2019-2020 National Health Interview Survey (NHIS) Longitudinal Cohort (NHIS-LC), a nationally representative of noninstitutionalized US adult civilians. Our outcome, HICP, was defined as pain which limited life or work activities most days or every day in the last 3 months (vs. never or some days). We included adults aged 18+ with complete data and no HICP at baseline (n=9,195). For “sleep troubles” and “fatigue symptoms”, we used two questions, respectively, about how often in the last 2 weeks they had been bothered by: “trouble falling or staying asleep, or sleeping too much”, and “feeling tired or having little energy” (not at all [reference], several days, more than half the days, or nearly every day). Two survey-weighted Poisson regression models estimated the effect of sleep troubles and fatigue symptoms, with HICP incidence, adjusted for age, sex, race/ethnicity, family income, and depressive symptoms.

Results

The population-weighted 1-year cumulative incidence of HICP was 4.2%. Individuals who reported sleep troubles more than half the days, and several days at baseline (vs. not at all), were more likely to develop HICP 1 year later (Adjusted relative risk [aRR], 95% confidence interval [CI] = 1.99, 1.28 to 3.10, p = 0.002; and aRR, 95%CI = 1.55, 1.10-2.18, p = 0.011, respectively). Those who reported fatigue symptoms several days, more than half of the days, and nearly every day at baseline (vs. not at all) were more likely to develop HICP 1 year later (aRR, 95%CI = 1.79, 1.31 to 2.45, p = < 0.001; aRR, 95%CI = 1.66, 1.00 to 2.75, p = 0.050; aRR, 95%CI = 2.66, 1.76 to 4.02 p = < 0.001, respectively).

Conclusions

This study reveals a significant effect of both sleep troubles and fatigue symptoms on the incidence of HICP at a one-year follow-up. These results underscore the importance of addressing sleep-related issues in preventing HICP and enhancing our understanding of the complex interplay between sleep, fatigue, and chronic pain impact at the population level.

References

1. Nahin RL, Feinberg T, Kapos FP, Terman GW. Estimated Rates of Incident and Persistent Chronic Pain Among US Adults, 2019-2020. JAMA Netw Open. 2023;6(5):e2313563.
2. Afolalu EF, Ramlee F, Tang NKY. Effects of sleep changes on pain-related health outcomes in the general population: A systematic review of longitudinal studies with exploratory meta-analysis. Sleep medicine reviews. 2018;39:82-97.
3. Van de Langenberg SCN, Kocevska D, Luik AI. The multidimensionality of sleep in population-based samples: a narrative review. Journal of sleep research. 2022;31(4):e13608.

Presenting Author

Alberto Herrero Babiloni

Poster Authors

Alberto Herrero Babiloni

MSc

McGill University

Lead Author

E-mail

Barbara Fonseca Alonso

Private practice

Lead Author

E-mail

Marc O Martel

PhD

McGill University

Lead Author

E-mail

Gilles J. Lavigne

DMD

University of Monteal

Lead Author

E-mail

Kenneth A. Taylor

DPT

Komodo Health, San Francisco

Lead Author

E-mail

Adam Goode

DPT

Duke University

Lead Author

E-mail

Flavia Penteado Kapos

Duke University

Lead Author

E-mail

Topics

  • Lifestyle Issues: Sleep/Diet/Exercise/Social Interactions