Vitiello Michael V, McCurry Susan M, Shortreed Susan M, Baker Laura D, Rybarczyk Bruce D, Keefe Francis J, Von Korff Michael
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA Group Health Research Institute, Seattle, WA, USA Department of Internal Medicine and Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA Duke University Medical Center, Durham, NC, USA.
Pain. 2014 Aug;155(8):1547-1554. doi: 10.1016/j.pain.2014.04.032. Epub 2014 May 1.
In a primary care population of 367 older adults (aged ⩾60 years) with osteoarthritis (OA) pain and insomnia, we examined the relationship between short-term improvement in sleep and long-term sleep, pain, and fatigue outcomes through secondary analyses of randomized controlled trial data. Study participants, regardless of experimental treatment received, were classified either as improvers (⩾30% baseline to 2-month reduction on the Insomnia Severity Index [ISI]) or as nonimprovers. After controlling for treatment arm and potential confounders, improvers showed significant, sustained improvements across 18 months compared with nonimprovers in pain severity (P<0.001, adjusted mean difference=-0.51 [95% CI: -0.80, -0.21), arthritis symptoms (P<0.001, 0.63 [0.26, 1.00]), and fear avoidance (P=0.009, -2.27 [-3.95, -0.58]) but not in catastrophizing or depression. Improvers also showed significant, sustained improvements in ISI (P<0.001, -3.03 [-3.74, -2.32]), Pittsburgh Sleep Quality Index Total (P<0.001, -1.45 [-1.97, -0.93]) and general sleep quality (P<0.001, -0.28 [-0.39, -0.16]) scores, Flinders Fatigue Scale (P<0.001, -1.99 [-3.01, -0.98]), and Dysfunctional Beliefs About Sleep Scale (P=0.037, -2.44 [-4.74, -0.15]), but no improvements on the Functional Outcomes of Sleep Questionnaire or the Epworth Sleepiness Scale. We conclude that short-term (2-month) improvements in sleep predicted long-term (9- and 18-month) improvements for multiple measures of sleep, chronic pain, and fatigue. These improvements were not attributable to nonspecific benefits for psychological well-being, such as reduced depression. These findings are consistent with benefits of improved sleep for chronic pain and fatigue among older persons with osteoarthritis pain and comorbid insomnia if robust improvements in sleep are achieved and sustained.
ClinicalTrials.gov Identifier: NCT01142349.
在一个由367名患有骨关节炎（OA）疼痛和失眠的老年人（年龄≥60岁）组成的初级保健人群中，我们通过对随机对照试验数据的二次分析，研究了短期睡眠改善与长期睡眠、疼痛和疲劳结果之间的关系。研究参与者，无论接受何种实验治疗，都被分类为改善者（失眠严重程度指数[ISI]从基线到2个月降低≥30%）或非改善者。在控制了治疗组和潜在混杂因素后，与非改善者相比，改善者在18个月内疼痛严重程度（P<0.001，调整后平均差异=-0.51[95%CI：-0.80，-0.21]）、关节炎症状（P<0.001，0.63[0.26，1.00]）和恐惧回避（P=0.009，-2.27[-3.95，-0.58]）方面有显著且持续的改善，但在灾难化或抑郁方面没有改善。改善者在ISI（P<0.001，-3.03[-3.74，-2.32]）、匹兹堡睡眠质量指数总分（P<0.001，-1.45[-1.97，-0.93]）和总体睡眠质量（P<0.001，-0.28[-0.39，-0.16]）得分、弗林德斯疲劳量表（P<0.001，-1.99[-3.01，-0.98]）和睡眠功能失调信念量表（P=0.037，-2.44[-4.74，-0.15]）方面也有显著且持续的改善，但在睡眠问卷功能结果或爱泼华嗜睡量表方面没有改善。我们得出结论，短期（2个月）睡眠改善预示着长期（9个月和18个月）在多种睡眠、慢性疼痛和疲劳测量指标上的改善。这些改善并非归因于对心理健康的非特异性益处，如抑郁减轻。如果实现并维持睡眠的显著改善，这些发现与改善睡眠对患有骨关节炎疼痛和共病失眠的老年人慢性疼痛和疲劳的益处一致。
ClinicalTrials.gov标识符：NCT01142349。
