The association between sleep quality, low back pain and disability: A prospective study in routine practice

Kovacs, Francisco M.; Seco, Jesús; Royuela, Ana; Betegon-Nicolas, Jesus; Sánchez-Herraéz, S.; Meli, Marcelo; Rodríguez, Mario; Núñez, Marian Amanda Vázquez; Álvarez-Galovich, Luis; Moyá, Jordi; Sanchez, Carlos E.; Luna, Sofía Cristina Martínez; Borrego, Pedro; Moix, Jenny; Pérez, Vicente Rodríguez; Torres-Unda, Jon; Burgos-Alonso, Natalia; Gago-Fernández, Inés; González-Rubio, Y.; Abraira, Víctor

doi:10.1002/ejp.1095

Cited by 30 publications

(21 citation statements)

References 39 publications

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“…In our sample, 11% of participants with chronic LBP had concomitant insomnia, which was lower than the 55-59% reported in other studies [4][5][6]. This was expected as our insomnia definition required daytime impairment as in the DSM-5 criteria for insomnia, rather than the any symptoms of insomnia.…”

Section: Answer C) Is Presence Of Insomnia Associated With the Prevalence Of Chronic Lbp?contrasting

confidence: 52%

“…Chronic LBP is the top cause for years lived with disability in The Global Burden of Disease study 2013 [3]. Insomnia symptoms are highly prevalent in individuals with chronic LBP, with 55-59% of sufferers [4][5][6] reporting insomnia symptoms, such as poor sleep quality, non-restorative sleep, waking up too early, and difficulty initiating and maintaining sleep [7,8].…”

Section: Introductionmentioning

confidence: 99%

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The association between insomnia, c-reactive protein, and chronic low back pain: cross-sectional analysis of the HUNT study, Norway

Simić

Småstuen

et al. 2019

Scandinavian Journal of Pain

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Background and aims Chronic low back pain (chronic LBP) is the number one cause for years lived with disability among 301 diseases and injuries analyzed by The Global Burden of Disease study 2013. Insomnia is highly prevalent among people with chronic LBP. To explain the sleep-pain relationship, theoretical models propose that insomnia symptoms may be associated with increased basal inflammation, operationalized as c-reactive protein (CRP) and lead to further pain and disrupted sleep. We aimed to determine the associations between insomnia, chronic LBP, and inflammation (operationalized as CRP), whilst controlling for age, body mass index, smoking, physical activity, depression, anxiety and osteoarthritis. Methods A cross-sectional analysis of the third Nord-Trøndelag Health Study (2006–2008), a rural population survey of 50,666 participants in Norway aged 20–96 years. Insomnia (dichotomous) was defined according to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, and chronic LBP (dichotomous) as low back pain or stiffness lasting at least 3 months. Data for CRP were obtained from non-fasting serum samples and assessed via latex immunoassay methodology. We excluded participants with the following self-reported chronic somatic diseases: chronic heart failure, chronic obstructive pulmonary disease, rheumatoid arthritis, fibromyalgia or ankylosing spondylosis. Possible associations between presence of insomnia and presence of chronic LBP (dependent), and the level of CRP and presence of chronic LBP (dependent), were assessed using logistic regression models. The possible association between insomnia and CRP (dependent) was assessed using linear regression. Multivariable analyses were conducted adjusting for confounders stated in our aim that achieved p ≤ 0.2 in univariate regressions. We performed stratified analyses for participants with “Normal” (<3 mg/L) “Elevated” (3–10 mg/L) and “Very High” (>10 mg/L) levels of CRP. Results In our total included sample (n = 30,669, median age 52.6, 54% female), 6.1% had insomnia (n = 1,871), 21.4% had chronic LBP (n = 6,559), and 2.4% had both (n = 719). Twenty four thousand two hundred eighty-eight (79%) participants had “Normal” CRP, 5,275 (17%) had “Elevated” CRP, and 1,136 (4%) had “Very High” CRP. For participants with “Normal” levels of CRP, insomnia was associated with higher levels of CRP (adjusted B = 0.04, 95%CI [0.00–0.08], p = 0.046), but not for people with “Elevated” or “Very High” levels of CRP. There was an association between CRP and presence of chronic LBP in the total sample (adjusted OR = 1.01, [1.00–1.01], p = 0.013) and for people with “Normal” CRP (1.05, [1.00–1.10, p = 0.034]. Insomnia was associated with the presence of chronic LBP in the total sample (adjusted OR = 1.99, 95%CI [1.79–2.21], <0.001) and for people with “Normal”, “Elevated” and “Very High”. Conclusions Individuals with insomnia have twice the odds of reporting chronic LBP. Insomnia, CRP and chronic LBP appear to be linked but the role of CRP appears to be limited. Longitudinal studies may help further explore the causal inference between insomnia chronic LBP, and inflammation. Implications Given the strong relationship between insomnia and chronic LBP, screening and management of comorbid insomnia and chronic LBP should be considered in clinical practice. Further longitudinal studies are required to explore whether the presence of insomnia and increased inflammation affects the development of chronic LBP.

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Section: Answer C) Is Presence Of Insomnia Associated With the Prevalence Of Chronic Lbp?contrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

The association between insomnia, c-reactive protein, and chronic low back pain: cross-sectional analysis of the HUNT study, Norway

Simić

Småstuen

et al. 2019

Scandinavian Journal of Pain

View full text Add to dashboard Cite

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“…Similarly, research conducted in US military hospitals among 757 participants reported that sleep disorder is significantly associated with LBP-related health visits among the military population (Rhon et al, 2019). In addition, a cohort study conducted among adults reported improvement in LBP with increased sleep quality (Kovacs et al, 2018). However, there is a lack of research articles regarding the quantity and quality of sleep required to recover from strenuous military drills.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of non-specific chronic low-back pain and risk factors among male soldiers in Saudi Arabia

Sidiq

Alenazi

Kashoo

et al. 2021

PeerJ

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Background Non-specific chronic low back pain (NSCLBP) is the most common musculoskeletal disorder affecting health and work among the military population. NSCLBP is a complex disorder with several risk factors contributing to its occurrence. Therefore, the objective of our study was to estimate the prevalence and contribution of risk factors towards NSCLBP among male soldiers in Saudi Arabia. Methods A cross-sectional study was conducted from March 2020 to January 2021 among the military personnel at Hafar Al-Batin military base, Saudi Arabia. The entire population (n = 62, 000) at the military base were invited to participate in the study. The participants were invited to participate in the study either through direct referral from in-patient and out-patient departments of the military hospital or by invitation through pamphlets, email, and advertisement across the offices and residential areas. Soldiers reporting lower back pain for at least 12 weeks were screened for inclusion criteria at the physical therapy department of the military hospital. Inclusion criteria included pain or discomfort originating from the lower back without any known spinal diseases. Participants with a systemic inflammatory disorder, trauma, neurological symptoms, and recent spinal surgery were excluded. All eligible participants were assessed for demographic variables and risk factors and complete the Rolland Morris Disability Questionnaire and WHO-Five Well-Being Index. Results This study identified a 46.3% prevalence of pain originating from the spine with a 2.7% prevalence of NSCLBP. Spearman’s rho correlation between the severity of disability due to NSCLBP was strongly associated with age (rs = 0.834, p < 0.01), quality of sleep (rs = 0.790, p < 0.01), body mass index (BMI) (rs = 0.617, p < 0.01), smoking (rs = 0.520, p < 0.01), co-morbidity (rs = 0.357, p < 0.01), but not with the level of physical activity (rs = 0.044, p = 0.07). Conclusion There was a high prevalence of pain originating from the spine among male Saudi soldiers with a relatively low prevalence of NSCLBP. However, the prevalence of disability due to NSCLBP was strongly associated with age, sleep quality, BMI, smoking habit, and co-morbidity.

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“…A recent Spanish study sought to test it scientifically, investigating the association between sleep quality and low back pain in routine clinical practice. 1 A total of 461 patients with lower back pain were recruited from both primary and secondary care, and followed up after 3 months. Patients who had an improvement in sleep during the follow-up period also had improvements in lower back pain and disability.…”

Section: Sleep Quality Febrile Seizures Interpreters and Doulasmentioning

confidence: 99%

Yonder: Sleep quality, febrile seizures, interpreters, and doulas

Rashid¹

2018

Br J Gen Pract

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The association between sleep quality, low back pain and disability: A prospective study in routine practice

Abstract: In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

Cited by 30 publications

References 39 publications

The association between insomnia, c-reactive protein, and chronic low back pain: cross-sectional analysis of the HUNT study, Norway

The association between insomnia, c-reactive protein, and chronic low back pain: cross-sectional analysis of the HUNT study, Norway

Prevalence of non-specific chronic low-back pain and risk factors among male soldiers in Saudi Arabia

Yonder: Sleep quality, febrile seizures, interpreters, and doulas

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