Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA.
Ann Behav Med. 2021 Jun 2;55(6):580-591. doi: 10.1093/abm/kaaa099.
There are emerging data indicating that sleep disturbance may be linked with an increase in opioid use. The majority of sickle cell disease (SCD) patients experience sleep disturbances, which can elevate pain severity and pain catastrophizing, both of which are important predictors of opioid consumption.
We conducted a preliminary investigation on the association between previous night sleep disturbance and short-acting opioid use, as well as the potential mediating roles of pain severity and pain catastrophizing. Because sex is associated with sleep disturbance, pain-related experiences, and opioid use, we also explored the potential moderating role of sex.
Participants were 45 SCD patients who were prescribed opioids. For 3 months, sleep diaries were collected immediately upon participants' awakening. Daily pain severity, pain catastrophizing, and prescription opioid use measures were collected before bedtime.
Multilevel structural equation modeling revealed that wake time after sleep onset (WASO) during the previous night (Time 1) predicted greater short-acting opioid use during the next day (Time 2). Pain severity and pain catastrophizing measured during the next day (Time 2) also mediated the association between the two. Sex moderation analysis showed that the positive association between WASO and pain severity was largely driven by women.
These findings provide some preliminary evidence as to the mechanism linking sleep continuity disturbance and opioid requirement in SCD patients. Future studies should replicate and extend these findings with clearer temporal information and employing more refined measures of sleep continuity and prescription opioid use in a larger sample.
有新的数据表明，睡眠障碍可能与阿片类药物使用增加有关。大多数镰状细胞病（SCD）患者都经历睡眠障碍，这会加重疼痛的严重程度和疼痛灾难化，这两者都是阿片类药物使用的重要预测因素。
我们对前一晚睡眠障碍与短效阿片类药物使用之间的关系进行了初步研究，以及疼痛严重程度和疼痛灾难化的潜在中介作用。由于性别与睡眠障碍、与疼痛相关的体验和阿片类药物使用有关，我们还探讨了性别的潜在调节作用。
参与者为 45 名接受阿片类药物治疗的 SCD 患者。在 3 个月的时间里，参与者一醒来就立即收集睡眠日记。在睡前收集每日疼痛严重程度、疼痛灾难化和处方阿片类药物使用的测量值。
多层次结构方程模型显示，前一晚的睡眠后觉醒时间（WASO）（时间 1）预测了下一天短效阿片类药物使用的增加（时间 2）。下一天（时间 2）测量的疼痛严重程度和疼痛灾难化也介导了两者之间的关联。性别调节分析表明，WASO 与疼痛严重程度之间的正相关主要是由女性驱动的。
这些发现为睡眠连续性障碍与 SCD 患者阿片类药物需求之间的关联提供了一些初步证据。未来的研究应该在更大的样本中复制和扩展这些发现，使用更清晰的时间信息和更精细的睡眠连续性和处方阿片类药物使用测量方法。
