Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK. Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK.
Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK.
Rheumatology (Oxford). 2015 Feb;54(2):248-56. doi: 10.1093/rheumatology/keu283. Epub 2014 Aug 14.
Pain, the most common manifestation of rheumatological conditions, is highly prevalent among older adults, with worse health outcomes found in those with co-morbid insomnia. Proactive prevention of insomnia may reduce the overall disease burden of pain and rheumatological conditions. To inform such development, this study examined the role of pain, physical limitation and reduced social participation in predicting and mediating insomnia onset.
A prospective cohort study was conducted involving 6676 individuals ≥50 years of age who completed questionnaires at baseline and a 3-year follow-up. Participants were classified into none, some and widespread pain according to the ACR criteria. Logistic regression was used to examine the relationship between baseline pain and insomnia onset at 3 years. Path analysis was used to test for the mediating role of physical limitation and social participation restriction.
Some [adjusted odds ratio (AOR) 1.57 (95% CI 1.15, 2.13)] and widespread [2.13 (1.66, 3.20)] pain increased the risk of insomnia onset at 3 years, after adjusting for age, gender, socio-economic class, education, anxiety, depression, sleep and co-morbidity at baseline. The combination of physical limitation and reduced social participation explained up to 68% of the effect of some pain on insomnia onset and 66% of the effect of widespread pain on insomnia onset.
There was a dose-response association between the extent of pain at baseline and insomnia onset at 3 years that was substantially mediated by physical limitation and reduced social participation. Targeting physical limitation and social participation in older people with pain may buffer co-morbid insomnia, reducing the overall disease burden.
疼痛是风湿性疾病最常见的表现形式，在老年人中普遍存在，同时患有失眠的患者健康状况更差。积极预防失眠可能会降低疼痛和风湿性疾病的整体疾病负担。为了提供信息支持，本研究考察了疼痛、身体受限和社交参与减少在预测和介导失眠发作中的作用。
进行了一项前瞻性队列研究，涉及 6676 名年龄在 50 岁及以上的个体，他们在基线和 3 年随访时完成了问卷调查。根据 ACR 标准，参与者被分为无疼痛、某些部位疼痛和广泛疼痛。使用逻辑回归检验基线时疼痛与 3 年后失眠发作之间的关系。使用路径分析检验身体受限和社交参与受限的中介作用。
某些部位疼痛（调整后的优势比[OR] 1.57（95%置信区间[CI] 1.15，2.13））和广泛疼痛（2.13（1.66，3.20））增加了 3 年后失眠发作的风险，调整了基线时的年龄、性别、社会经济阶层、教育程度、焦虑、抑郁、睡眠和共病情况。身体受限和社交参与减少的组合解释了某些疼痛对失眠发作的影响的 68%，以及广泛疼痛对失眠发作的影响的 66%。
基线时疼痛程度与 3 年后失眠发作之间存在剂量反应关系，这种关系主要由身体受限和社交参与减少介导。在有疼痛的老年人中针对身体受限和社交参与进行干预可能会缓冲共病性失眠，从而降低整体疾病负担。
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