Wilson Keith G, Watson Shannon T, Currie Shawn R
Institute for Rehabilitation Research and Development, The Rehabilitation Centre, 505 Smyth Road, Ottawa, Ontario, K1H 8M2, Canada Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
Pain. 1998 Mar;75(1):75-84. doi: 10.1016/S0304-3959(97)00207-8.
Insomnia is a significant problem for many people with chronic pain. In this study, we used a combination of daily sleep diaries and ambulatory activity monitoring (actigraphy) to: (i) examine the nature and severity of the sleep disturbance in this patient group; (ii) determine the concordance between sleep diary and actigraph measures of different sleep parameters; (iii) assess the reliability of sleep parameters across nights; and (iv) identify the clinical correlates of insomnia severity. Forty subjects with insomnia associated with chronic musculoskeletal pain completed questionnaires addressing clinical issues of pain severity, medication use, sleep quality, and affective distress. For 2 consecutive nights, each subject then completed a sleep diary and wore an actigraph unit on the non-dominant wrist. The results showed that the sleep diaries and the actigraphs provided similar estimates of total sleep time, time awake after sleep onset, and sleep efficiency, but differed in the measurement of sleep onset latency and nocturnal awakenings. Both methods of assessment exhibited low to moderate reliability across nights. Measures of the same sleep parameters across the two methods of assessment showed low concordance. Of the clinical variables, pain severity had the strongest association with disturbed sleep, but only using the diary method of assessment. Subjects who reported high pain severity also reported greater sleep impairment than subjects with low pain severity, but this was not confirmed by actigraphy. In general, both methods of assessment point to the significance of insomnia associated with chronic musculoskeletal pain as a distinct clinical problem, but the activity monitoring and self-report procedures provide different information. These findings suggest that multi-method assessment is an important consideration for studies of insomnia in patients with chronic pain.
失眠是许多慢性疼痛患者面临的一个重要问题。在本研究中，我们结合使用每日睡眠日记和动态活动监测（活动记录仪）来：（i）检查该患者群体睡眠障碍的性质和严重程度；（ii）确定睡眠日记与活动记录仪对不同睡眠参数测量结果的一致性；（iii）评估各夜睡眠参数的可靠性；以及（iv）确定失眠严重程度的临床相关因素。40名患有与慢性肌肉骨骼疼痛相关失眠的受试者完成了关于疼痛严重程度、药物使用、睡眠质量和情感困扰等临床问题的问卷调查。然后，每位受试者连续两晚完成一份睡眠日记，并在非优势手腕上佩戴一个活动记录仪。结果显示，睡眠日记和活动记录仪对总睡眠时间、睡眠开始后清醒时间和睡眠效率的估计相似，但在睡眠开始潜伏期和夜间觉醒的测量上存在差异。两种评估方法在各夜的可靠性均为低到中度。两种评估方法对相同睡眠参数的测量结果一致性较低。在临床变量中，疼痛严重程度与睡眠障碍的关联最强，但仅在使用日记评估方法时如此。报告疼痛严重程度高的受试者也报告了比疼痛严重程度低的受试者更大的睡眠障碍，但活动记录仪未证实这一点。总体而言，两种评估方法都表明与慢性肌肉骨骼疼痛相关的失眠作为一个独特的临床问题具有重要意义，但活动监测和自我报告程序提供了不同的信息。这些发现表明，多方法评估是慢性疼痛患者失眠研究的一个重要考虑因素。
