Ikemiya Hiroko, Yamada Keiko, Chiba Satoko, Hamaoka Saeko, Hara Atsuko, Yamaguchi Keisuke, Iseki Masako, Kawagoe Izumi
Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Neuropsychopharmacol Rep. 2025 Sep;45(3):e70052. doi: 10.1002/npr2.70052.
Although opioid analgesics may influence sleep in patients with chronic pain, the association between strong opioid use and sleep characteristics remains unclear. This study aimed to explore differences in sleep status among chronic pain patients with varying levels of opioid use.
A total of 29 patients with chronic non-cancer pain who had been under treatment for more than 6 months were included. Patients were divided into four groups based on their opioid use: non-opioid users (n = 11), weak opioid users (n = 8), and strong opioid users receiving either < 60 mg/day (n = 5) or ≥ 60 mg/day (n = 5) in morphine-equivalent doses. Pain and psychological factors were assessed using the Numerical Rating Scale, Pain Catastrophizing Scale, Hospital Anxiety and Depression Scale, and Japanese Perceived Stress Scale. Subjective sleep status was assessed using the Athens Insomnia Scale. Objective sleep parameters, including total sleep duration, wakefulness after sleep onset (WASO), and sleep efficiency, were measured over seven nights using the wearable device. Sleep data were analyzed using a linear mixed-effects model with the opioid-naive group as the reference. Model 1 was unadjusted; Model 2 adjusted for age, sex, pain intensity, catastrophizing, anxiety, depression, and stress.
Patients in the ≥ 60 mg/day group showed shorter total sleep duration, longer WASO, and lower sleep efficiency in Model 1 compared to non-opioid users. These trends remained in Model 2, although statistical significance decreased. In contrast, those receiving < 60 mg/day showed trends toward shorter WASO and higher sleep efficiency. Subjective insomnia symptoms were more frequent in both strong opioid groups, especially in the high-dose group.
Among patients with chronic non-cancer pain, high-dose strong opioid use tended to be associated with poorer sleep, while low-dose use was linked to more favorable sleep characteristics.
尽管阿片类镇痛药可能会影响慢性疼痛患者的睡眠，但强效阿片类药物的使用与睡眠特征之间的关联仍不明确。本研究旨在探讨不同阿片类药物使用水平的慢性疼痛患者的睡眠状况差异。
纳入29例接受治疗超过6个月的慢性非癌性疼痛患者。根据阿片类药物使用情况将患者分为四组：非阿片类药物使用者（n = 11）、弱阿片类药物使用者（n = 8），以及接受吗啡当量剂量<60mg/天（n = 5）或≥60mg/天（n = 5）的强效阿片类药物使用者。使用数字评定量表、疼痛灾难化量表、医院焦虑抑郁量表和日本感知压力量表评估疼痛和心理因素。使用雅典失眠量表评估主观睡眠状况。使用可穿戴设备在七个晚上测量客观睡眠参数，包括总睡眠时间、睡眠起始后觉醒时间（WASO）和睡眠效率。以未使用阿片类药物的组作为对照，使用线性混合效应模型分析睡眠数据。模型1未进行调整；模型2对年龄、性别、疼痛强度、灾难化、焦虑、抑郁和压力进行了调整。
与非阿片类药物使用者相比，在模型1中，≥60mg/天组的患者总睡眠时间更短，WASO更长，睡眠效率更低。在模型2中这些趋势仍然存在，尽管统计学显著性降低。相比之下，接受<60mg/天的患者WASO有缩短趋势，睡眠效率有提高趋势。两个强效阿片类药物组的主观失眠症状更常见，尤其是高剂量组。
在慢性非癌性疼痛患者中，高剂量强效阿片类药物的使用往往与较差的睡眠相关，而低剂量使用则与更有利的睡眠特征相关。
