Pain as a mediator of sleep problems in arthritis and other chronic conditions

• Published in: Arthritis and rheumatism 2005-12, Vol.53 (6), p.911-919
• Main Authors: Power, J. Denise, Perruccio, Anthony V., Badley, Elizabeth M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Arthritis; Arthritis - epidemiology; Arthritis - physiopathology; Biological and medical sciences; Canada - epidemiology; Chronic disease; Comorbidity; Cross-Sectional Studies; Diseases of the osteoarticular system; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Dyssomnias - diagnosis; Dyssomnias - epidemiology; Female; Humans; Life Style; Logistic Models; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Nervous system (semeiology, syndromes); Neurology; Pain; Pain - epidemiology; Sleep; Sleep Initiation and Maintenance Disorders - diagnosis; Sleep Initiation and Maintenance Disorders - epidemiology
• ISSN: 0004-3591; 0893-7524; 1529-0131; 1529-0123
• DOI: 10.1002/art.21584

Objective To examine the associations between arthritis and insomnia symptoms and unrefreshing sleep, as well as the role of pain as a mediator of these relationships. Methods Analyses were conducted on the cross‐sectional, nationally representative, weighted sample of adults ≥18 years of age (n = 118,336) in the 2000/2001 Canadian Community Health Survey. Four logistic regression models were estimated for each sleep problem (model 1: arthritis only; model 2: model 1 + sociodemographic characteristics, lifestyle factors, and other chronic conditions; model 3: model 2 + mental health [stress, depression]; and model 4: model 3 + pain). Mediation by pain was quantified by the percentage change in the effect of arthritis on a particular sleep problem by comparing models 3 and 4. Results The prevalence of insomnia symptoms and unrefreshing sleep in persons with arthritis was 24.8% and 11.9%, respectively. These estimates are twice as high as those for persons without arthritis. In multivariate regression analyses, the addition of pain decreased the effect of arthritis by 53% (insomnia symptoms) and 64% (unrefreshing sleep). The effect of arthritis was still statistically significant in these models, suggesting that pain is a partial mediator of these relationships. Conclusion Insomnia symptoms and unrefreshing sleep affect a considerable proportion of individuals with arthritis. Pain mediates a substantial amount of the relationship between arthritis and sleep problems. Better pain management could significantly improve sleep in individuals with arthritis.