Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; WHO Collaborating Center for Vaccine Safety, Santiago de Compostela, Spain; Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago de Compostela, Galicia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain.
Br J Anaesth. 2023 Jun;130(6):747-762. doi: 10.1016/j.bja.2023.02.036. Epub 2023 Apr 12.
Chronic pain and depression represent two global health problems with considerable economic consequences. Although existing literature reports on the relation between depression and pain conditions, meta-analytic evidence backing the mediating role of sleep disturbance as one of the main symptoms of depression is scarce. To examine the extent to which sleep disturbance mediates the depression-chronic pain association, we conducted a systematic review and meta-analysis of the associations of chronic pain, depression, and sleep quality.
We systematically searched for literature in MEDLINE and other relevant databases and identified cohort and case-control studies on depression, sleep disturbance, and chronic pain. Forty-nine studies were eligible, with a total population of 120 489 individuals. We obtained direct and indirect path coefficients via two-stage meta-analytic structural equation modelling, examined heterogeneity via subgroup analyses, and evaluated primary studies quality.
We found a significant, partial mediation effect of sleep disturbance on the relation between depression and chronic pain. The pooled path coefficient (coef.) of the indirect effect was 0.03 (95% confidence interval [CI]: 0.01-0.05) and accounted for 12.5% of the total effect of depression on chronic pain. This indirect effect also existed for cohort studies (coef. 0.02; 95% CI: 0.002-0.04), European studies (coef. 0.03; 95% CI: 0.004-0.05), and studies that adjusted for confounders (coef. 0.04; 95% CI: 0.01-0.09).
Sleep disturbance partially mediates the association between depression and pain. Although plausible mechanisms could explain this mediation effect, other explanations, including reverse causation, must be further explored.
PROSPERO CRD42022338201.
慢性疼痛和抑郁是两个具有重大经济后果的全球健康问题。尽管现有文献报告了抑郁与疼痛状况之间的关系，但作为抑郁主要症状之一的睡眠障碍的中介作用的元分析证据却很少。为了研究睡眠障碍在多大程度上介导了抑郁与慢性疼痛之间的关联，我们对慢性疼痛、抑郁和睡眠质量的相关性进行了系统的文献回顾和荟萃分析。
我们系统地在 MEDLINE 和其他相关数据库中搜索文献，并确定了关于抑郁、睡眠障碍和慢性疼痛的队列研究和病例对照研究。共有 49 项研究符合条件，总人群为 120489 人。我们通过两阶段荟萃分析结构方程模型获得直接和间接路径系数，通过亚组分析检查异质性，并评估主要研究的质量。
我们发现，睡眠障碍对抑郁与慢性疼痛之间的关系存在显著的部分中介作用。间接效应的合并路径系数（coef.）为 0.03（95%置信区间[CI]：0.01-0.05），占抑郁对慢性疼痛总效应的 12.5%。这种间接效应也存在于队列研究（coef. 0.02；95%CI：0.002-0.04）、欧洲研究（coef. 0.03；95%CI：0.004-0.05）和调整了混杂因素的研究（coef. 0.04；95%CI：0.01-0.09）中。
睡眠障碍部分介导了抑郁与疼痛之间的关联。虽然可以用一些可能的机制来解释这种中介效应，但还需要进一步探讨其他解释，包括反向因果关系。
PROSPERO CRD42022338201。
