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Objectives: To investigate the association between sleep disturbance and clinical features of chronic whiplash-associated disorders (WAD). We also aimed to use a bootstrapped mediation analysis approach to systematically examine both direct and indirect pathways by which sleep disturbance may affect chronic pain and functional status.Materials and Methods: One hundred sixty-five people (63% female) with chronic WAD and not taking medications for sleep disturbance completed questionnaires evaluating sleep disturbance, pain intensity, pain interference, disability, physical and mental health quality of life, stress, anxiety, depression, pain catastrophizing, and posttraumatic stress severity.Results: Greater sleep disturbance was associated with increased duration of symptoms, higher levels of pain and disability, higher levels of emotional distress and pain catastrophizing, and functional impairment (reduced health-related quality of life). Mediation analyses demonstrated that sleep disturbance influenced chronic pain intensity and interference through both direct and indirect associations inclusive of stress, anxiety, and pain catastrophizing. Similarly, sleep disturbance was associated with higher levels of disability and poor health-related quality of life, both directly and also through its negative association with pain intensity and interference.Discussion: Sleep disturbance in chronic WAD was associated with worse health outcomes and demonstrated both direct and indirect effects on both chronic pain and function.

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Infection with helminth parasites can prevent or reduce the severity of colitis and airway inflammation in murine models of human inflammatory bowel disease and asthma. We postulated that infection with H. diminuta, which is spontaneously expelled from mice, would ameliorate the inflammation evoked by direct injection of Freund's complete adjuvant (FCA) into the knee joint, as a model of inflammatory joint disease. Male mice were orally gavaged with 5 viable H. diminuta cysticercoids in 100μl PBS and 8 days later received FCA (50 μl) into the right knee joint. Controls: a) PBS gavage + PBS knee injection, b) H. diminuta gavage + PBS injection, c) PBS gavage + FCA injection. Knee diameter was measured over a 7 day period and on sacrifice, blood samples were collected, spleen cells stimulated for cytokine production, knee joints extracted for myeloperoxidase (MPO) activity and RT‐PCR performed for cytokine mRNA expression. Mice infected with H. diminuta were significantly protected from FCA‐induced arthritis as shown by reduced knee swelling, fewer circulating neutrophils, lower MPO levels in the joint and reduced splenocyte TNFα production. Thus, our results show that prior infection with the helminth parasite, H. diminuta, significantly protects mice from the arthritic effects of FCA. Funded by CIHR.