2019 HSR&D/QUERI National Conference

4120 — Daily Deviations in Sleep Quality: Implications for Pain and its Management

Lead/Presenter: Mary Driscoll,  COIN - West Haven
All Authors: Driscoll MA (VA Connecticut, Yale School of Medicine), Buta, E (Yale Center for Analytical Sciences), Grinberg, A (VA Connecticut) Higgins, D (VA Boston, Boston University) MacLean, RR (VA Connecticut, Yale School of Medicine) Edmond, S (VA Connecticut, Yale School of Medicine) Ankawi, B (VA Connecticut) LaChappelle, K (VA Connecticut) Heapy, AA (VA Connecticut, Yale School of Medicine)

Sleep disturbances are common among people with chronic pain. The gold standard in pain self-management, cognitive behavioral therapy for chronic pain (CBT-CP) targets sleep hygiene as a standard component of treatment. Much of the existing literature focuses on total sleep time with less attention paid to sleep quality. The current investigation examines associations between daily fluctuations in sleep quality on next day reports of a) pain intensity, b) activity levels, and c) pain skills practice among Veterans enrolled in a CBT-CP program. Additional exploratory analyses probed potential predictors of sleep quality.

One hundred eleven Veterans [77% male, Mean Age = 58.15 (SD 11.53)] with chronic back pain participating in a non-inferiority trial comparing in-person CBT-CP to CBT-CP delivered via interactive voice response (IVR) completed daily diary measures of pain intensity (0-10), step count, sleep quality (0-10), pain coping skills practice (0-10), and pain catastrophizing (1-5), over an 11-week period. Demographics and disease status were assessed at baseline. Hierarchical linear modeling was utilized to examine the association between daily sleep quality and next day measures of pain, steps, and pain skills practice.

In models controlling for time in treatment, treatment group, age, gender, number of pain sites, prior day pain intensity, and mean sleep quality, daily sleep quality predicted pain intensity (b = -0.17 (95%CI -0.19, -0.15), p < .0001) and pain skills practice (b = 0.19 (95%CI 0.15, 0.23), p < .0001), but not step count (b = 30.33 (95%CI -12.14, 72.81), p = 0.16). An exploratory model probing potential predictors of sleep quality revealed that higher levels of daily catastrophizing and higher baseline levels of depression were significantly and negatively associated with sleep quality.

On days following better sleep quality, Veterans reported lower pain and greater use of pain self-management strategies. Poorer sleep quality followed days marked by higher pain catastrophizing.

Findings reinforce the established clinical importance of targeting sleep and catastrophizing in chronic pain. They also underscore the relevance of these variables in daily adaptation to pain. Clinically, efforts to target daily fluctuations in sleep and catastrophizing may result in proximal improvements in both pain intensity and pain self-management.