Caroline A Sabin1,2, Richard Harding3, Nicki Doyle4, Susan Redline5,6, Davide de Francesco1, Patrick W G Mallon7, Frank A Post8, Marta Boffito9, Memory Sachikonye10, Adam Geressu1, Alan Winston11, Ken M Kunisaki12. 1. Institute for Global Health, UCL, London, United Kingdom. 2. Health Protection Research Unit (HPRU), National Institute for Health Research (NIHR), Blood-Borne and Sexually Transmitted Infections, UCL in Partnership with Public Health England (PHE). 3. Florence Nightingale Faculty, Cicely Saunders Institute, Kings College London, London, United Kingdom. 4. Department of Infectious Disease, Imperial College London, London, United Kingdom. 5. Departments of Medicine and Neurology, Harvard Medical School, Brigham and Women's Hospital. 6. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 7. HIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland. 8. Caldecot Centre, King's College Hospital, London, United Kingdom. 9. St. Stephen's Centre, Chelsea and Westminster Hospital, London, United Kingdom. 10. UK Community Advisory Board (UK-CAB), London, United Kingdom. 11. Imperial Clinical Trials Unit, Imperial College London, London, United Kingdom; and. 12. Minneapolis Veterans Affairs Health Care System, University of Minnesota, Minnesota, MN.
Abstract
BACKGROUND: We investigate the association of widespread pain with sleep quality among people with HIV and HIV-negative controls. SETTING: UK-based cohort. METHODS: Pain information was collected through a pain mannikin identifying affected body sites; pain was classified as widespread if pain was reported in ≥4 of 5 body regions and in ≥7 of 15 body sites, and as regional otherwise. Sleep was assessed a median of 3.2 years later through 7-night actigraphy and through self-reported assessments of sleep quality. Chi-squared tests, Kruskal-Wallis tests, and linear/logistic regression considered associations between pain extent and sleep quality. RESULTS: Of the 414 participants, 74 (17.9%) reported widespread and 189 (45.7%) regional pain. Although there were few clear associations between actigraphy outcomes and pain extent, those with widespread and regional pain consistently reported poorer sleep quality on all self-reported measures than those with no pain. Median (interquartile range) insomnia severity index and Patient-reported Outcomes Measurement Information System (PROMIS) for sleep disturbance and sleep-related impairment scores were 12 (7-16), 55.3 (48.0-58.9), and 57.2 (48.9-61.3), respectively, for those with widespread pain, 8 (4-13), 51.2 (45.5-58.3), and 50.3 (43.6-56.1) for those with regional pain, and 5 (2-9), 47.9 (42.9-54.3), and 45.5 (41.4-50.3) for those with no pain (all P values 0.0001). Associations remained strong after adjustment for HIV status and other confounders, and were reduced but remained significant, after adjustment for depressive symptoms. CONCLUSIONS: Widespread pain was not associated with objective measures of sleep but was strongly associated with self-reported assessments of sleep quality in people with HIV.
BACKGROUND: We investigate the association of widespread pain with sleep quality among people with HIV and HIV-negative controls. SETTING: UK-based cohort. METHODS: Pain information was collected through a pain mannikin identifying affected body sites; pain was classified as widespread if pain was reported in ≥4 of 5 body regions and in ≥7 of 15 body sites, and as regional otherwise. Sleep was assessed a median of 3.2 years later through 7-night actigraphy and through self-reported assessments of sleep quality. Chi-squared tests, Kruskal-Wallis tests, and linear/logistic regression considered associations between pain extent and sleep quality. RESULTS: Of the 414 participants, 74 (17.9%) reported widespread and 189 (45.7%) regional pain. Although there were few clear associations between actigraphy outcomes and pain extent, those with widespread and regional pain consistently reported poorer sleep quality on all self-reported measures than those with no pain. Median (interquartile range) insomnia severity index and Patient-reported Outcomes Measurement Information System (PROMIS) for sleep disturbance and sleep-related impairment scores were 12 (7-16), 55.3 (48.0-58.9), and 57.2 (48.9-61.3), respectively, for those with widespread pain, 8 (4-13), 51.2 (45.5-58.3), and 50.3 (43.6-56.1) for those with regional pain, and 5 (2-9), 47.9 (42.9-54.3), and 45.5 (41.4-50.3) for those with no pain (all P values 0.0001). Associations remained strong after adjustment for HIV status and other confounders, and were reduced but remained significant, after adjustment for depressive symptoms. CONCLUSIONS: Widespread pain was not associated with objective measures of sleep but was strongly associated with self-reported assessments of sleep quality in people with HIV.
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