Friis Joakim, Sandahl Hinuga, Mortensen Erik Lykke, Svendsen Kristina Bacher, Jennum Poul, Carlsson Jessica
Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
J Sleep Res. 2025 Aug;34(4):e14407. doi: 10.1111/jsr.14407. Epub 2024 Nov 28.
Poor sleep quality is well recognised in both post-traumatic stress disorder (PTSD) and pain conditions. Comorbid chronic pain is prevalent in populations with PTSD and is believed to maintain symptoms of PTSD and increase the complexity of the condition. Ongoing diminished sleep quality may serve to maintain pain and PTSD symptoms, and thus affect the efficacy of first-line PTSD treatment. This study examined the mechanisms underlying the PTSD-pain relationship over time by investigating if perceived sleep quality mediates the relationship between PTSD symptom severity and levels of pain interference. Furthermore, we considered whether the interrelation between these three variables could in fact be linked in an alternative model where the causality was reversed, with pain interference mediating the relation between PTSD severity and perceived sleep quality. Relationships among our variables were assessed within a path analysis framework, conducted and controlled for covariates using structural equation modelling and mediation analysis. The analysis of our hypothesised model revealed that improvement in perceived sleep quality was a significant partial mediator of the association between reduction in PTSD severity and pain interference. Approximately 28% of the effect of PTSD severity on pain interference was mediated by improvement in perceived sleep quality. Evaluation of our alternative model revealed a non-significant mediation effect. Sleep thus represents a modifiable mechanism that contributes to the mutual maintenance of PTSD and pain. The study is the first to investigate these relationships in trauma-affected refugees and thus contributes new knowledge and clinical implications for the treatment of poor sleep quality and pain symptomatology in trauma-affected refugees.
睡眠质量差在创伤后应激障碍（PTSD）和疼痛状况中都已得到充分认识。共病的慢性疼痛在PTSD人群中很普遍，并且被认为会维持PTSD的症状并增加病情的复杂性。持续的睡眠质量下降可能会维持疼痛和PTSD症状，从而影响PTSD一线治疗的效果。本研究通过调查感知睡眠质量是否介导PTSD症状严重程度与疼痛干扰水平之间的关系，来研究PTSD与疼痛关系随时间变化的潜在机制。此外，我们还考虑了这三个变量之间的相互关系是否实际上可以在一个因果关系颠倒的替代模型中联系起来，即疼痛干扰介导PTSD严重程度与感知睡眠质量之间的关系。我们在路径分析框架内评估变量之间的关系，使用结构方程建模和中介分析对协变量进行处理和控制。对我们假设模型的分析表明，感知睡眠质量的改善是PTSD严重程度降低与疼痛干扰之间关联的一个重要部分中介因素。PTSD严重程度对疼痛干扰的影响中约28%是由感知睡眠质量的改善介导的。对我们替代模型的评估显示中介效应不显著。因此，睡眠是一种可调节的机制，有助于PTSD和疼痛的相互维持。该研究首次在受创伤的难民中调查这些关系，从而为治疗受创伤难民的睡眠质量差和疼痛症状学提供了新的知识和临床意义。
