Nonspecific pain is a marker for hypovitaminosis D in patients undergoing evaluation for sleep disorders: a pilot study

Abstract

BackgroundThe purpose of this cross-sectional study was to test the hypothesis that serum vitamin D levels are abnormally low in sleep clinic patients admitting to chronic nonspecific musculoskeletal pain and to assess the associated risk factors. A secondary purpose was to identify a clinical biomarker for vitamin D deficiency.MethodsWe enrolled 153 consecutive patients who admitted to the presence of chronic nonspecific musculoskeletal pain during a comprehensive sleep evaluation at a specialist sleep medicine clinic within an academic center. Venous blood sampling was performed for determination of serum 25-hydroxyvitamin D. Risk factors for vitamin D deficiency (25-hydroxyvitamin D < 20 ng/mL) were identified by odds ratios. Receiver-operating characteristic curve analysis was performed with 10-fold cross-validation to identify a biomarker for vitamin D deficiency calculated by linear discriminant analysis.ResultsThe mean serum 25-hydroxyvitamin D level was 19.8 ± 11.1, with 54% of the study population having vitamin D deficiency. This mean 25-hydroxyvitamin D level was lower than that observed historically in healthy controls, and was either similar or lower than in all but one representative historical cohort formed on the basis of chronic nonspecific musculoskeletal pain. Risk factors for vitamin D deficiency were black ethnicity, age < 60 years, and obesity. These risk factors were identified both in the entire cohort and separately in subgroups with and without obstructive sleep apnea. The biomarker (based on race, age, and body mass index) had a sensitivity and specificity for predicting vitamin D deficiency of 0.73 and 0.74, respectively.ConclusionVitamin D deficiency was prevalent in patients with sleep disorders and chronic nonspecific musculoskeletal pain on evaluation in a sleep medicine clinic. Vitamin D deficiency was reliably estimated in the study population using a biomarker derived from common demographic characteristics.

The interfaces between vitamin D, sleep and pain

“…A study evaluating the effects of cholecalciferol supplementation (1200 IU/ day to individuals with serum 25OHD between 20 and 29 ng/mL and 50,000 IU/weekly to those with serum 25OHD <20 ng/mL) in veterans with multiple areas of chronic pain found a decrease in self-reported pain in both supplemented groups, as well as an improvement in sleep pattern, with decreased sleep latency and increased sleep duration (Huang et al 2013). In another study, patients with nonspecific chronic pain selected from a sleep clinic showed serum 25OHD levels <20 ng/mL (McCarty et al 2013). The risk factors for the decrease of vitamin D status in this study were ethnicity, obesity and age.…”

Symptom burden, fatigue, sleep quality and perceived social support in hemodialysis patients with musculoskeletal discomfort: a single center experience from Egypt

“…Remarkably, the pathophysiological interactions of CKD-MBD including vit D deficiency and consequent hypocalcemia greatly predispose to MSDs in patients with ESKD [ 1 ]. Similarly, an association has been reported between decreased vitamin D levels and musculoskeletal pain in the general population [ 42 , 43 ]. As well, there has been an association between chronic anemia and musculoskeletal disorders [ 44 ].…”

A secosteroid and not just a food for thought

“…Most of these studies have methodological flaws, heterogeneous cohort, smaller sample size and are underpowered to address this issue. However, the majority of the reports from different populations have documented lower vitamin D levels in vague aches and pain than reference populations . Correlation between low back pain in people with modic changes and vitamin D insufficiency also do exist in the literature .…”