Effects of sleep changes on pain-related health outcomes in the general population: A systematic review of longitudinal studies with exploratory meta-analysis

Abstract

SummaryEmerging longitudinal research has highlighted poor sleep as a risk factor of a range of adverse health outcomes, including disabling pain conditions. In establishing the causal role of sleep in pain, it remains to be clarified whether sleep deterioration over time is a driver of pain and whether sleep improvement can mitigate pain-related outcomes. A systematic literature search was performed using PubMed MEDLINE, Ovid EMBASE, and Proquest PsycINFO, to identify 16 longitudinal studies involving 61,000 participants. The studies evaluated the effect of sleep changes (simulating sleep deterioration, sleep stability, and sleep improvement) on subsequent pain-related outcomes in the general population. A decline in sleep quality and sleep quantity was associated with a two- to three-fold increase in risk of developing a pain condition, small elevations in levels of inflammatory markers, and a decline in self-reported physical health status. An exploratory meta-analysis further revealed that deterioration in sleep was associated with worse self-reported physical functioning (medium effect size), whilst improvement in sleep was associated with better physical functioning (small effect size). The review consolidates evidence that changes in sleep are prospectively associated with pain-related outcomes and highlights the need for further longitudinal investigations on the long-term impact of sleep improvements.

The Pain of Sleep Loss: A Brain Characterization in Humans

“…Insufficient sleep, self-reported, has been shown to correlate, cross-sectionally, with self-reported pain in a sample of the general population (Smith and Haythornthwaite, 2004;Afolalu et al, 2018) and clinical cohorts (Tang et al, 2012). Our findings add to this link by establishing that, beyond cross-sectional associations, changes in the quality of night-to-night sleep within an individual in a micro-longitudinal assay, more so than the quantity, predict consequential day-to-day changes in pain intensity (Edwards et al, 2008).…”

“…This not only represents an extended test of the central sleep-pain hypothesis, complementing experimental acute sleep deprivation manipulations, but further determines whether such findings hold public health relevance. Previous survey studies have established that sleep disruption and pain are significantly linked (Afolalu et al, 2018). However, these studies use cross-sectional analyses at a single time point, and in clinical populations (e.g., chronic pain and/or insomnia) (Tang et al, 2012).…”

Phase II double-blind randomised controlled trial of exogenous administration of melatonin in chronic pain (DREAM—CP): a study protocol

“…Current understanding is that pain and sleep are inextricably linked via a bidirectional relationship: pain disrupts sleep and poor quality or shorter duration of sleep can increase sensitivity to painful stimuli 8. Poor sleep quality and insufficient sleep duration are risk factors for the development of chronic pain 8 9. Neurobiological mechanisms linking sleep and pain are not fully understood but are likely to involve multiple hormonal, chemical and immunological pathways 8 10…”

Associations between Sleep Disorders and Comfort at End-of-Life: Opportunities for Improvement

“…It is imperative, therefore, to understand the effects of sleep disorders on comfort for noncancer patients at EOL. Similarly, associations between sleep and pain are well-understood [6][7][8] while associations between sleep and other comfort factors are less well-known. Therefore, the purpose of this review of the literature is to explore and quantify the association between sleep disorder/disturbance and non-pain comfort at EOL among people without cancer, as it may be possible to improve comfort and QoL by addressing sleep quality among individuals https://doi.org/10.17241/smr.2018.00276 facing life-limiting illness.…”