Sleep Quality and Efficiency in Adolescents With Chronic Pain: Relationship With Activity Limitations and Health-Related Quality of Life

Abstract

The primary purpose of this report was to test hypothesized relationships among poorer sleep quality, increased activity limitations, and reduced health-related quality of life (HRQOL) in adolescents with and without chronic pain. Forty adolescents (20 with chronic pain, 20 healthy) completed measures of HRQOL, activity limitations, pain, depression, and sleep quality. Actigraphy was completed over 7 days. Correlational analyses demonstrated significant relationships where poorer subjective sleep quality was associated with greater activity limitations and reduced HRQOL. Lower actigraphic sleep efficiency was associated with greater activity limitations. In multiple regression analyses, frequency of pain predicted activity limitations and HRQOL. Controlling for pain and depression, lower sleep efficiency was a significant predictor of greater activity limitations but not of HRQOL. Adolescents with chronic pain would benefit from thorough assessment and treatment of sleep disturbances, as alleviation of sleep complaints might enhance HRQOL and physical functioning in this population.

Actigraphy Reliability with Normal Sleepers

“…Some studies make no attempt to use the event markers to record bedtime and arising time, relying entirely on diaries to determine the sleep period (e.g., Rowe et al, 2008). Additionally, some studies report they revert to the diary to replace missing actigraphy data (e.g., Palermo, Fonareva, & Janosy, 2008). We identified two studies which reported rates of missing data in actigraphic assessment of sleep.…”

Psychosocial determinants of headache, abdominal pain, and sleep problems in a community sample of Finnish adolescents

“…Moreover, pain may cause sleep problems, whereas insufficient sleep increases the perception of pain [9,10]. Headache, abdominal pain and sleep problems have been similarly associated with psychiatric problems [8,[11][12][13][14]. However, the specific associations between these health complaints and psychopathology, as well as the underlying mechanisms still remain unclear [15][16][17].…”

“…Pain and sleep problems cause school absenteeism [23], and hospital admissions [24]. They are costly for the community [25,26] that have a major impact on the quality of life [13], and are associated with psychiatric and somatic problems in adulthood [27,28].…”

Bidirectional associations between pain and physical activity in adolescents

“…Prior studies have found associations among pain, depressive symptoms, and physical activity 12 . Moreover, poorer sleep quality is related to daily pain and greater activity limitations 19,20 in adolescents with chronic pain. Medication use in adolescents with chronic pain may have considerable impact on relationships between pain and activity.…”