Sivertsen Børge, Lallukka Tea, Petrie Keith J, Steingrímsdóttir Ólöf Anna, Stubhaug Audun, Nielsen Christopher Sivert
Division of Mental Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway Department of Psychiatry, Helse Fonna HF, Haugesund, Norway Finnish Institute of Occupational Health, Helsinki, Finland Department of Public Health, University of Helsinki, Helsinki, Finland Department of Psychological Medicine, University of Auckland, Auckland, New Zealand Department of Health Statistics, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Pain. 2015 Aug;156(8):1433-1439. doi: 10.1097/j.pain.0000000000000131.
Sleep problems and pain are major public health concerns, but the nature of the association between the 2 conditions is inadequately studied. The aim of this study was to determine whether a range of sleep measures is associated with experimental increased pain sensitivity. A cross-sectional large population-based study from 2007 to 2008, the Tromsø 6 study, provided data from 10,412 participants (age: mean [SD], 58 [13] years; 54% women). Self-reported sleep measures provided information on sleep duration, sleep onset latency (SOL), and sleep efficiency, as well as frequency and severity of insomnia. The main outcome measure was pain sensitivity tests, including assessment of cold-pressor pain tolerance. We found that all sleep parameters, except sleep duration, were significantly associated with reduced pain tolerance. Both the frequency and severity of insomnia, in addition to SOL and sleep efficiency, were associated with pain sensitivity in a dose-response manner. Adjusting for demographics and psychological distress reduced the strengths of the hazard ratios, but most associations remained significant in the fully adjusted models. There was also a synergistic interaction effect on pain tolerance when combining insomnia and chronic pain. We conclude that sleep problems significantly increase the risk for reduced pain tolerance. Because comorbid sleep problems and pain have been linked to elevated disability, the need to improve sleep among patients with chronic pain, and vice versa, should be an important agenda for future research.
睡眠问题和疼痛是主要的公共卫生问题，但这两种情况之间关联的本质尚未得到充分研究。本研究的目的是确定一系列睡眠指标是否与实验性增加的疼痛敏感性相关。2007年至2008年进行的一项基于人群的横断面大型研究——特罗姆瑟6研究，提供了10412名参与者的数据（年龄：平均[标准差]，58[13]岁；54%为女性）。自我报告的睡眠指标提供了关于睡眠时间、入睡潜伏期（SOL）、睡眠效率以及失眠频率和严重程度的信息。主要结局指标是疼痛敏感性测试，包括冷加压疼痛耐受性评估。我们发现，除睡眠时间外，所有睡眠参数均与疼痛耐受性降低显著相关。失眠的频率和严重程度，以及SOL和睡眠效率，均与疼痛敏感性呈剂量反应关系。对人口统计学和心理困扰进行调整后，风险比的强度有所降低，但在完全调整模型中，大多数关联仍然显著。失眠和慢性疼痛同时存在时，对疼痛耐受性也有协同交互作用。我们得出结论，睡眠问题会显著增加疼痛耐受性降低的风险。由于睡眠问题和疼痛共病与残疾程度升高有关，改善慢性疼痛患者的睡眠状况以及反之亦然，应该成为未来研究的重要议程。
