Increased age is associated with normative declines in both sleep and cognitive functioning. Although there are some inconsistencies in the literature, negative sleep changes are associated with worse cognitive functioning. This negative relationship holds true across normal-sleeping older adults, older adults with insomnia, older adults with sleep disordered breathing, cognitively healthy older adults, and older adults with dementia. There are mixed results regarding potential benefits of sleep treatments on cognitive functions; however, this line of research deserves added attention because the potential mechanisms of action are likely distinct from other interventions to improve cognition.

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BackgroundAfrican Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited engagement of African Americans in the development and evaluation of behavioral interventions for management of OA. Pain Coping Skills Training (CST) is a cognitive-behavioral intervention with shown efficacy to improve OA-related pain and other outcomes. Emerging data indicate pain CST may be a promising intervention for reducing racial disparities in OA symptom severity. However, there are important gaps in this research, including incorporation of stakeholder perspectives (e.g. cultural appropriateness, strategies for implementation into clinical practice) and testing pain CST specifically among African Americans with OA. This study will evaluate the effectiveness of a culturally enhanced pain CST program among African Americans with OA.Methods/DesignThis is a randomized controlled trial among 248 participants with symptomatic hip or knee OA, with equal allocation to a pain CST group and a wait list (WL) control group. The pain CST program incorporated feedback from patients and other stakeholders and involves 11 weekly telephone-based sessions. Outcomes are assessed at baseline, 12 weeks (primary time point), and 36 weeks (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include self-efficacy, pain coping, pain interference, quality of life, depressive symptoms, and global assessment of change. Linear mixed models will be used to compare the pain CST group to the WL control group and explore whether participant characteristics are associated with differential improvement in the pain CST program. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, Durham Veterans Affairs Medical Center, East Carolina University, and Duke University Health System.DiscussionThis culturally enhanced pain CST program could have a substantial impact on outcomes for African Americans with OA and may be a key strategy in the reduction of racial health disparities.Trial registrationClinicalTrials.gov, NCT02560922, registered 9/22/2015.

Purpose Primary brain tumor (PBT) patients report sleep disturbance due to their disease and treatment, yet few studies have utilized validated measures to understand the extent of patients’ concerns and preferences for treatment. The purpose of this quality improvement project was to determine the prevalence and associated risk factors of sleep disturbance among PBT patients in our clinic and to evaluate interest in treatment for sleep disturbance. Methods PBT patients completed validated measures of sleep disturbance and health during routine neuro-oncology visits. Patients also reported on sleep-related symptom management and their preferences for pharmacological and/or behavioral treatment. Results Sleep disturbance was common, with 61.5% of PBT patients ( N = 119; M age = 52.60 years; 50% male) reporting poor sleep quality and 21.5% endorsing symptoms of insomnia. Insomnia could be explained by increased fatigue and corticosteroid use; sleep quality could be explained by fatigue. Patients in our clinic with higher grade tumors, significant sleep disturbance, of minority racial/ethnic status, and those not already taking sleep medications were more likely to report their symptoms and were not well-addressed by their medical team. Patients indicated a similar interest in pharmacological and behavioral treatment, warranting the availability of both in our clinic. Conclusions Findings indicate a high prevalence of sleep disturbance in PBT patients, highlighting the need for increased screening, monitoring, and treatment in our neuro-oncology clinic. Future research would benefit from assessing the efficacy of behavioral treatments for sleep disturbance in this population. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06476-3.

Summary Poor sleep and chronic pain are known to be interrelated, but the influence of negative and positive affect on this relationship is not fully understood. The present study sought to examine whether negative and positive affect mediate the relationship between sleep and pain interference. Secondary data analysis from Midlife in the United States (MIDUS‐III) was used to examine 948 individuals with chronic pain (mean age = 64.73 years). Sleep disturbance was conceptualized as the sum of self‐reported difficulty with sleep‐onset latency, wake after sleep onset, early morning awakening and daytime sleepiness, and total sleep time was assessed via self‐reported sleep duration. Pain interference was operationalized as the sum of pain‐related interference with general activity, relationships and enjoyment of life. Finally, items from the Positive and Negative Affect Schedule were used to measure affect. Mediation analyses revealed that sleep disturbance indirectly predicted pain interference via both negative affect (β = 0.15, confidence interval: 0.10, 0.21) and positive affect (β = 0.18, confidence interval: 0.12, 0.25). Similarly, negative (β = −0.003, confidence interval: −0.01, −0.001) and positive affect (β = −0.003, confidence interval: −0.01, −0.001) also mediated the effect between total sleep time and pain interference. This study highlights the unique role of negative and positive affect on pain interference for individuals with chronic pain in mid‐ to late‐life. Additionally, findings suggest that holistic treatment approaches, which assess both sleep and affect in the context of chronic pain, may be beneficial.