Sleep problems increase the risk of musculoskeletal pain in boys but not girls: a prospective cohort study

Abstract

Adults with sleep problems are at higher risk for onset of musculoskeletal pain, but the evidence is less clear for children. This prospective cohort study investigated whether children with sleep problems are at higher risk for onset of musculoskeletal pain and explored whether sex is a modifier of this association. In a prospective cohort study of Australian schoolchildren (n = 1239, mean age 9 years), the associations between sleep problems at baseline and new onset of both musculoskeletal pain and persistent musculoskeletal pain (pain lasting > 3 months) 1 year later were investigated using logistic regression. The potential modifying effect of sex was also assessed. One-year incidence proportion for musculoskeletal pain onset is 43% and 7% for persistent musculoskeletal pain. Sleep problems were associated with musculoskeletal pain onset and persistent musculoskeletal pain onset in boys, odds ratio 2.80 (95% CI 1.39, 5.62) and OR 3.70 (1.30, 10.54), respectively, but not girls OR 0.58 (0.28, 1.19) and OR 1.43 (0.41, 4.95), respectively. Conclusions: Rates of musculoskeletal pain are high in children. Boys with sleep problems are at greater risk of onset of musculoskeletal pain, but girls do not appear to have higher risk. Consideration of sleep health may help prevent persistent musculoskeletal pain in children. What is Known:• Sleep problems are associated with the onset of musculoskeletal pain in adults.• It is not clear if the association between sleep problems and the onset of musculoskeletal pain is present also in children and if sex plays a role in this association. What is New:• This is the first large population-based study that has prospectively investigated the relationship between sleep problems and onset of musculoskeletal pain in school-aged children.• Children, especially boys with sleep problems, were at increased risk for the development of persistent musculoskeletal pain.

Are psychological symptoms a risk factor for musculoskeletal pain in adolescents?

“…Musculoskeletal pain was common in this cohort (> 40%), in agreement with findings of other cohorts that used similar pain assessment methods [ 39 ]. Whilst previous research has shown mixed effects of psychological symptoms on later adolescent musculoskeletal pain [ 14 – 20 ], there is support for the current findings.…”

“…Potential bias due to missing data was assessed by inspecting the percentage of missingness for each variable, and missing data were replaced through a chained equation multiple imputation method in order to maximize statistical power and increase precision (i.e. to limit the possibility of a biased estimate) [37,38]. All raw variables used in the analysis (i.e.…”

“…All raw variables used in the analysis (i.e. internalizing, externalizing, sex, puberty, physical activity, smoking, marijuana, drug use) were included in the imputation model [37,38]. The outcome was included in the imputation model, but not imputed.…”

“…The outcome was included in the imputation model, but not imputed. A number of datasets (n = 35) higher than the highest percentage of missing data among the variables (33% for the variable "puberty") were created [37,38]. All data was checked for distribution and multicollinearity prior to data analysis.…”

The Role of Sleep in the Transition from Acute to Chronic Musculoskeletal Pain in Youth—A Narrative Review

“…Indeed, 50–60% of adolescents with chronic pain problems report sleep deficiency [ 17 ]. The relationship between sleep deficiency and chronic pain has often been described as bi-directional, although evidence suggests that sleep is a stronger predictor of pain rather than vice versa [ 19 , 20 , 21 ]. However, despite this knowledge, sleep disturbance is not included in existing conceptual models of acute to chronic pain transition.…”