睡眠障碍与慢性疼痛强度和功能的关系：直接和间接途径的检验。
Associations Between Sleep Disturbance and Chronic Pain Intensity and Function: A Test of Direct and Indirect Pathways.
机构信息
Department of Psychiatry, University of Michigan, Ann Arbor, MI.
Departments of Behavioral Sciences.
出版信息
Clin J Pain. 2019 Jul;35(7):569-576. doi: 10.1097/AJP.0000000000000711.
OBJECTIVES
Sleep disturbance and chronic pain are related. The present study evaluated both direct and indirect (mediated) pathways through which sleep disturbance might be related to chronic pain intensity and function.
METHODS
In total, 87 individuals (64% female) with chronic low back pain but not using opioids daily completed questionnaires assessing their sleep disturbance, chronic pain intensity, function, depression, anxiety, positive affect, and catastrophizing.
RESULTS
Greater sleep disturbance was associated with greater pain intensity, worse function, greater emotional distress, lower positive affect, and higher levels of catastrophizing. Cross-sectional mediation analyses revealed that the positive associations between sleep disturbance and chronic pain intensity were conveyed statistically not only by significant indirect effects of elevated emotional distress, lower positive affect, and greater catastrophizing associated with sleep disturbance, but also by significant direct effects of sleep disturbance on chronic pain intensity. Similarly, we found that the associations between sleep disturbance and impaired function were conveyed statistically not only by significant indirect effects of elevated chronic pain intensity associated with sleep disturbance, but also by significant direct effects of sleep disturbance on function.
DISCUSSION
Sleep disturbance was related significantly with chronic pain intensity and function by both direct and indirect pathways. These results are consistent with an emerging literature highlighting the potential significance of sleep disturbance in chronic pain patients, and provide further support for addressing sleep disturbance in the assessment and management of chronic pain.
目的
睡眠障碍与慢性疼痛相关。本研究评估了睡眠障碍与慢性疼痛强度和功能相关的直接和间接（中介）途径。
方法
共有 87 名慢性下背痛但不每日使用阿片类药物的个体（64%为女性）完成了评估睡眠障碍、慢性疼痛强度、功能、抑郁、焦虑、积极情绪和灾难化的问卷。
结果
睡眠障碍越严重，疼痛强度越大，功能越差，情绪困扰越大，积极情绪越低，灾难化程度越高。横断面中介分析显示，睡眠障碍与慢性疼痛强度之间的正相关不仅通过与睡眠障碍相关的情绪困扰、积极情绪降低和灾难化程度升高的显著间接效应来传递统计学意义，而且还通过睡眠障碍对慢性疼痛强度的显著直接效应来传递统计学意义。同样，我们发现，睡眠障碍与功能受损之间的关联不仅通过与睡眠障碍相关的慢性疼痛强度升高的显著间接效应来传递统计学意义，而且还通过睡眠障碍对功能的显著直接效应来传递统计学意义。
讨论
睡眠障碍与慢性疼痛强度和功能通过直接和间接途径显著相关。这些结果与强调睡眠障碍在慢性疼痛患者中的潜在重要性的新兴文献一致，并为在慢性疼痛的评估和管理中解决睡眠障碍提供了进一步支持。
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