Background & Aims

There is a bidirectional relationship between sleep and pain disturbances (1,2). Sleep disturbances increase the risk for chronic pain, while chronic pain can interfere with sleep (3). Hence, we assessed the subjective sleep characteristics of youth with functional abdominal pain disorders (FAPDs) compared to healthy youth and examined associations with gastrointestinal symptoms. We hypothesized that youth with FAPDs would display worse sleep than healthy controls on validated self-and parent-report measures.

Methods

We included youth ages 10-18 years without a sleep or organic GI disorder diagnosis from a large public school in Cali, Colombia. Children diagnosed with sleep or organic gastrointestinal disorder were excluded. Participants completed demographics, baseline sleep history, and validated questionnaires: Rome 4 diagnostic questionnaire (R4DQ), sleep quality (ASWS-SF), insomnia (PISI), daytime sleepiness (ESS), sleep disturbance (PROMIS SD), and sleep-related impairment (PROMIS SRI). Cases (youth with FAPDs) completed abdominal pain index (API), nausea severity scale (NSS), anxiety (PROMIS anxiety), depression (PROMIS anxiety), and functional disability inventory (FDI) surveys. Parents filled sleep hygiene metrics (SHIP). Cases were matched 1:1 with controls based on age and gender.

Results

Of 120 youths (mean age 13.9 ± 1.9y, 60 cases 60 controls), 50% were females and 54.2% were mixed race. Youth with FAPDs took longer time to fall asleep (p=00.1), had worse daytime sleepiness (p=0.002), gasping/choking/snorting (p=0.03), and nightmares (p=0.01) than healthy peers. The groups did not differ based on sleep duration, snoring, respiratory pauses, tonsillectomy, sleepwalking, restless leg symptoms, and pre-sleep activities. Youth with FAPDs had worse insomnia (PISI, p=0.001), sleep disturbance (PROMIS SD, p<0.0001), sleep-related impairment (PROMIS SRI, p=0.0001), daytime sleepiness (ESS, p=0.002), sleep hygiene (SHIP, p=0.01). Higher insomnia severity (PISI) was associated with worse abdominal pain (API) (r=0.41, p<0.01), higher daytime sleepiness (ESS) with a family history of disorders of the gut-brain interaction (DGBIs) (OR=14.7, p=0.002), as well as higher sleep-related impairment (PROMIS SRI) (OR=5.6, p=0.02) and depression ((OR=6.1, p=0.01) with black race.

Conclusions

Youth with FAPDs have worse sleep than healthy youth and multiple sleep parameters are associated with abdominal pain. Future studies are needed to correlate sleep disturbance with GI symptoms and disability along with identify possible mechanisms by which sleep disturbances affect abdominal pain and vice versa.

References

1.Staffe AT, Bech MW, Clemmensen SLK, Nielsen HT, Larsen DB, Petersen KK. Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participants. PLoS One. 2019;14(12):e0225849.
2.Frohnhofen H. Pain and sleep : A bidirectional relationship. Z Gerontol Geriatr. 2018 Dec;51(8):871-874.
3.Koffel E, Kroenke K, Bair MJ, Leverty D, Polusny MA, Krebs EE. The bidirectional relationship between sleep complaints and pain: Analysis of data from a randomized trial. Health Psychol. 2016 Jan;35(1):41-9.

Presenting Author

Neha R Santucci

Poster Authors

Neha Santucci

MD

Cincinnati Children's Hospital Medical Center

Lead Author

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Carlos Alberto Velasco-Benitez

Universidad del Valle

Lead Author

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Daniela Alejandra Velasco-Suarez

Universidad Libre

Lead Author

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Christopher King

Cincinnati Children's Hospital Medical Center, Cincinnati, OH, US

Lead Author

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Kelly Byars

Cincinnati Children's Hospital Medical Center

Lead Author

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Thomas Dye

Cincinnati Children's Hospital Medical Center

Lead Author

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Jesse Li

Cincinnati Children's Hospital Medical Center

Lead Author

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Miguel Saps

University of Miami School of Medicine

Lead Author

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Topics

  • Specific Pain Conditions/Pain in Specific Populations: Visceral Pain – Gastrointestinal/Abdominal

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