Department of Psychology, Faculty of Health Sciences, The Arctic University of Norway.
Department of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø.
Clin J Pain. 2020 Sep;36(9):707-715. doi: 10.1097/AJP.0000000000000854.
Sleep disturbance is associated with persistence and exacerbation of chronic pain. As this relationship seems to be bidirectional, factors underpinning sleep disturbance may prove important in multimodal rehabilitation approaches. The aim of this cross-sectional study was to examine the impact of psychological symptoms on subjective and objective sleep measures in patients with chronic musculoskeletal pain (CMP), as compared with pain-free controls.
Sleep was assessed by self-report questionnaires, actigraphy, and polysomnography recordings in 56 patients (75.0% female; M age=41.7 y, SD=10.8 y) with CMP and compared with 53 matched pain-free controls (71.7% female; M age=41.8 y, SD=10.7). Mental distress (Hopkins Symptoms Checklist [HSCL]) and Pain Catastrophizing Scale (PCS) were tested as predictors of objective and subjective sleep measures in multiple regression models, and their indirect effects were tested in bootstrapped mediation models.
The sleep data revealed substantially more subjective sleep disturbance (Hedge g: 1.32 to 1.47, P<0.001), moderately worse sleep efficiency in the actigraphy measures (Hedges g: 0.5 to 0.6, P<0.01), and less polysomnography measured slow wave sleep (Hedges g: 0.43, P<0.05) in patients, as compared with controls. HSCL was strongly associated with the self-reported measures Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). HSCL also partially explained the association between pain and sleep, but HSCL was not associated with any of the objective sleep measures. More pain catastrophizing was related to less slow wave sleep.
The differences in subjective and objective sleep measures indicate that they probe different aspects of sleep functioning in patients with musculoskeletal pain, and their combined application may be valuable in clinical practice. Self-reported sleep disturbance seems to overlap with affective dimensions reflected by the HSCL questionnaire.
睡眠障碍与慢性疼痛的持续和恶化有关。由于这种关系似乎是双向的，因此，睡眠障碍的基础因素可能在多模式康复方法中很重要。本横断面研究的目的是检查心理症状对慢性肌肉骨骼疼痛（CMP）患者主观和客观睡眠测量的影响，并与无痛对照者进行比较。
通过自我报告问卷、活动记录仪和多导睡眠图记录评估 56 名 CMP 患者（75.0%女性；平均年龄=41.7 岁，标准差=10.8 岁）的睡眠，并与 53 名匹配的无痛对照组（71.7%女性；平均年龄=41.8 岁，标准差=10.7 岁）进行比较。在多元回归模型中，以精神困扰（霍普金斯症状清单[HSCL]）和疼痛灾难化量表（PCS）作为客观和主观睡眠测量的预测因子进行测试，并在 bootstrap 中介模型中测试其间接效应。
睡眠数据显示，患者的主观睡眠障碍明显更严重（Hedge g：1.32 至 1.47，P<0.001），活动记录仪测量的睡眠效率中度较差（Hedges g：0.5 至 0.6，P<0.01），多导睡眠图测量的慢波睡眠较少（Hedges g：0.43，P<0.05），与对照组相比。HSCL 与自我报告的量表失眠严重程度指数（ISI）和匹兹堡睡眠质量指数（PSQI）高度相关。HSCL 部分解释了疼痛与睡眠之间的关系，但 HSCL 与任何客观睡眠测量均无关。更多的疼痛灾难化与更少的慢波睡眠有关。
主观和客观睡眠测量的差异表明，它们在肌肉骨骼疼痛患者中探测到睡眠功能的不同方面，它们的联合应用在临床实践中可能是有价值的。自我报告的睡眠障碍似乎与 HSCL 问卷反映的情感维度重叠。
