Wilson Marian, Skeiky Lillian, Muck Rachael A, Honn Kimberly A, Williams Rhonda M, Jensen Mark P, Van Dongen Hans P A
College of Nursing, Washington State University, Spokane, WA 99202, USA.
Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA.
Mil Med. 2022 Mar 20;188(7-8):e2639-45. doi: 10.1093/milmed/usac065.
Veterans with chronic pain frequently report comorbid disruptions in sleep and psychological dysfunction. The purpose of this study was to investigate whether psychological function variables mediate the sleep-pain relationship. Knowledge regarding such contributing factors can inform the development and optimization of treatments for sleep disturbances and pain.
In an IRB-approved, registered clinical trial, we collected objective sleep data from U.S. military Veterans with chronic pain (N = 184, ages 23-81) using wrist actigraphy for 7 days and self-reported survey data assessing sleep quality, pain intensity, and psychological function (depression, anxiety, post-traumatic stress disorder, and pain catastrophizing). We investigated the associations between objectively measured and self-reported sleep quality and self-reported pain intensity. In addition, using parallel mediation analyses, we examined whether psychological function variables mediated these associations.
Actigraphy showed suboptimal sleep duration (less than 7 hours) and sleep fragmentation for most participants. Self-reported poor sleep quality and pain intensity were significantly correlated. Pain catastrophizing was found to mediate the association between self-reported sleep quality and pain intensity.
Sleep disturbances in this sample of Veterans with chronic pain included insufficient sleep, fragmented sleep, and perceived poor sleep quality. Analyses suggest that poor perceived sleep quality and pain intensity are mediated via pain catastrophizing. The finding highlights the potential importance of pain catastrophizing in Veterans with chronic pain. Future longitudinal research is needed to determine the extent to which treatments that reduce pain catastrophizing might also improve both sleep and pain outcomes.
患有慢性疼痛的退伍军人经常报告存在睡眠共病性紊乱和心理功能障碍。本研究的目的是调查心理功能变量是否介导睡眠与疼痛之间的关系。了解这些影响因素可为睡眠障碍和疼痛治疗方法的开发与优化提供依据。
在一项经机构审查委员会（IRB）批准并注册的临床试验中，我们使用手腕活动记录仪，对184名患有慢性疼痛的美国退伍军人（年龄在23 - 81岁之间）进行了7天的客观睡眠数据收集，并通过自我报告调查数据评估睡眠质量、疼痛强度以及心理功能（抑郁、焦虑、创伤后应激障碍和疼痛灾难化）。我们调查了客观测量的睡眠质量与自我报告的睡眠质量以及自我报告的疼痛强度之间的关联。此外，我们使用平行中介分析来检验心理功能变量是否介导了这些关联。
活动记录仪显示，大多数参与者的睡眠时间未达最佳（少于7小时）且睡眠碎片化。自我报告的睡眠质量差与疼痛强度显著相关。研究发现疼痛灾难化介导了自我报告的睡眠质量与疼痛强度之间的关联。
在这个患有慢性疼痛的退伍军人样本中，睡眠障碍包括睡眠不足、睡眠碎片化以及自我感觉睡眠质量差。分析表明，自我感觉睡眠质量差和疼痛强度是通过疼痛灾难化介导的。这一发现凸显了疼痛灾难化在患有慢性疼痛的退伍军人中的潜在重要性。未来需要进行纵向研究，以确定减轻疼痛灾难化的治疗方法在多大程度上也能改善睡眠和疼痛状况。
