Daytime and Nighttime Sleep Characteristics and Pain Among Adults With Stable Heart Failure.
Samantha Conley, Shelli L Feder, Sangchoon Jeon and 1 others
PMID 31365442WHAT IT FOUND
Pain tracked with insomnia symptoms, poor sleep quality, sleep medication use, longer sleep time, and daytime naps in 173 adults with stable heart failure.
Assess pain and sleep together, but this cannot show which causes which.
Key findings
01Insomnia symptoms, longer total sleep time on polysomnography, poorer sleep quality, more frequent sleep medication use, and more frequent daytime naps were significantly associated with more bodily pain.
02Actigraphy and polysomnography sleep variables were not significantly associated with pain, except snooze time.
03In stratified models, longer total sleep time and poorer sleep quality were associated with more pain among participants with insomnia, while sleep medication use and daytime naps were associated with more pain among participants without insomnia.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was cross-sectional, so it cannot show whether poor sleep causes pain, pain causes poor sleep, or both arise from another factor. This was a secondary analysis of an earlier study, so pain and sleep were not the original primary outcome. Participants with known sleep-disordered breathing were excluded, so the findings do not apply to heart failure patients with sleep apnea. Pain was measured with one general bodily pain scale, so the source, severity, and treatment of pain were not detailed. Sleep medication timing was not known relative to the sleep study night, so medication effects on measured sleep duration cannot be separated. Catastrophizing was not measured, so a possible explanation for longer time in bed and symptoms is missing. The multivariable model was built by stepwise selection from many sleep variables, so some associations may be chance.
Declared interests
The supplied metadata lists research support from NIH extramural and non-U.S. and U.S. government sources. The article text provided does not include a conflicts-of-interest declaration.
The easy way to misread this
Do not conclude that longer sleep or daytime naps cause more pain, or that telling patients to sleep less will help. The study was cross-sectional, and the timing of sleep medication use was not known.