Sleep phase and pre-sleep arousal predicted co-developmental trajectories of pain and insomnia within adolescence

Abstract

The onset of both chronic pain and insomnia is high during adolescence. Although a bidirectional relationship between pain and insomnia has support, how pain and sleep co-develop throughout adolescence remains unknown. Sleep–wake patterns, pre-sleep behavior and pre-sleep arousal may influence the co-development of pain and insomnia. Four waves of longitudinal self-report data were used (Nbaseline = 2767, Agebaseline M = 13.65 years, SD = 0.65). Multidimensional growth mixture modeling was used to identify four subgroups of adolescents with different concurrent trajectories of pain and insomnia. The trajectories followed each other across time in all classes: one class of consistently low pain and insomnia (68.7%), one class with persistent high symptoms (4.9%), as well as one class of increasing (13.9%), and one of decreasing (12.5%), trajectories. Later sleep–wake patterns and more pre-sleep cognitive-emotional arousal predicted both increasing and decreasing trajectories of concurrent pain and insomnia. The current study showed that developmental trajectories of pain and insomnia follow each other within adolescents and across adolescence. Both sleep-phase focused interventions as well as psychological interventions that focus on pre-sleep cognitive-emotional arousal may prove beneficial for adolescents with comorbid pain and insomnia.

Associations of Co-occurring Symptom Trajectories With Sex, Race, Ethnicity, and Health Care Utilization in Children

“…However, nearly 1 in 5 children had moderate to high co-occurring symptom trajectories that persisted or worsened for most. These rates align with reports of single symptom trajectories during adolescence suggesting concerning rates of persistent, recurrent, or worsening pain, anxiety and depression, and sleep disturbance symptoms . Notably, fewer than half of the children with moderate to high co-occurring symptom trajectories reported nonroutine HCU, even when scores reached at-risk or clinical levels.…”

“…These rates align with reports of single symptom trajectories during adolescence suggesting concerning rates of persistent, recurrent, or worsening pain, 6,8,10,18 anxiety and depression, 9,41 and sleep disturbance symptoms. 13,42 Notably, fewer than half of the children with moderate to high co-occurring symptom trajectories reported nonroutine HCU, even when scores reached at-risk or clinical levels. Furthermore, racially minoritized children, such as Black children, and those from lower Results from mixed effect multinomial regression including all trajectory groups, with the asymptomatic group used as the reference group; all covariates included in the analysis are depicted in the first column, with family and research site included as random intercepts.…”

“…Given previously described, variable associations across childhood, 13,17,18 we included measures of pain, anxiety, depression, and sleep disturbance symptoms to characterize our comorbid pain-PSS trajectories. Annual symptom assessments were derived from the parent-reported Child Behavior Checklist (CBCL) 30 and Sleep Disturbance Scale for Children (SDSC).…”

“…Indeed, 1 in 3 adolescents report persistent pain, and 1 in 5 adolescents report lingering depression or anxiety . Sleep disturbance accompanies persistent symptoms for as many as 17% of youths, compounding the symptom burden and its effects on academic, social, and emotional development . Such high rates of symptom persistence suggest that pain and mental health symptoms remain poorly recognized or addressed for many youths.…”

Sleep-EEG in comorbid pain and insomnia: implications for the treatment of pain disorders

“…Evidence from experimental and longitudinal studies suggests that an increased magnitude of sleep disturbance leads to increased pain sensitivity and that recovery of sleep continuity and quality leads to reduced pain sensitivity. 1 , 4 , 31 , 35 , 86 These findings support the premise that sleep disturbance—insomnia specifically—is a modifiable factor that can be improved through cognitive, behavioral, or pharmacological means to improve pain outcomes.…”