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The role of pain, physical disability, and reduced social participation in insomnia onset in community dwelling older adults : a prospective cohort study
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Tang, Nicole K. Y., McBeth, John, Jordan, Kelvin, Blagojevic-Bucknall, Milisa, Croft, Peter and Wilkie, Ross (2013) The role of pain, physical disability, and reduced social participation in insomnia onset in community dwelling older adults : a prospective cohort study. The Lancet, Volume 382 . Article number S95. doi:10.1016/S0140-6736(13)62520-9 ISSN 0140-6736.
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Official URL: http://dx.doi.org/10.1016/S0140-6736(13)62520-9
Abstract
Background
Most patients with chronic pain have insomnia that warrants clinical attention. This study examined the role of pain, physical disability, and reduced social participation in predicting and mediating insomnia onset in community dwelling older adults. Theories of pain-related insomnia identify activity dysregulation as a behavioural mechanism augmenting sleep disturbance. Participation in social and physical activities was hypothesised to be sleep promoting because engagement in activities generates sleep pressure and brings the exposure to light and stimulation that entrain the circadian rhythm.
Methods
We undertook a prospective cohort study based in North Staffordshire, UK (approved by the North Staffordshire Research Ethics Committee). 13 986 individuals aged at least 50 years were recruited from six general practices. 9457 respondents to the baseline questionnaire consented to further contact. 7230 completed responses were received at 3 years. Of these, 6676 had data at both timepoints and were used for the analysis. Pain was assessed by a body manikin. Participants were classified into no pain, regional pain, and widespread pain according to the American College of Rheumatology criteria of fibromyalgia, which count the number of reported pain sites. Insomnia was measured with the Jenkins sleep questionnaire. Mediators were physical disability and reduced social participation, respectively measured by the 36-item short form physical function subscale (PFS) and Keele Assessment of Participation (KAP). The association between baseline pain and insomnia onset at 3 years was examined with logistic regression among those who did not have insomnia at baseline. Path analysis was used to test the mediating role of physical disability and reduced social participation in the pain—insomnia relation.
Findings
At baseline, 1767 (26·5%) of 6676 participants had no pain, 3074 (46·0%) had regional pain, and 1835 (27·5%) had widespread pain. 491 (28·9%) of 1698 participants in the no pain group, 1814 (61·7%) of 2939 in the regional pain group, and 1515 (85·6%) of 1771 participants in the widespread pain group were moderately (50·1—84·9) or severely (0—50) disabled based on their PFS scores. 237 (13·4%) of 1767 of participants in the no pain group, 749 (24·3%) of 3074 in the regional pain group, and 766 (41·7%) of 1835 participants in the widespread pain group reported at least two social participation restrictions on the KAP. Regional pain (adjusted odds ratio 1·83, 95% CI 1·54—2·18) and widespread pain (2·86, 2·35—3·48) increased the risk of developing insomnia at 3 years, after adjustment for age, sex, social economic class, education attainment, anxiety, depression, and sleep at baseline. The combination of physical disability and reduced social participation explained up to 74% of the total effect of regional pain and 70% of the effect of widespread pain on insomnia onset. Probability weighted analyses to assess the effect of attrition suggested no differences in the reported association between the weighted and unweighted analyses.
Interpretation
There was a dose—response association between the extent of pain at baseline and insomnia onset at 3 years. The effect of pain on subsequent insomnia onset was mediated by physical disability and reduced social participation. If these two factors are reasonable proxies of reduced engagement in activities, interventions that strengthen them in older adults with pain may buffer the risk of insomnia onset. These interpretations, however, are based on self-reported data and might not generalise to communities of different cultural and demographic characteristics
Item Type: | Journal Article | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Science > Psychology | ||||
Journal or Publication Title: | The Lancet | ||||
Publisher: | Lancet Publishing Group | ||||
ISSN: | 0140-6736 | ||||
Official Date: | 29 November 2013 | ||||
Dates: |
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Volume: | Volume 382 | ||||
Article Number: | Article number S95 | ||||
DOI: | 10.1016/S0140-6736(13)62520-9 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access | ||||
Funder: | Medical Research Council (Great Britain) (MRC) | ||||
Grant number: | (G9900220) |
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