Sleep Quality, Affect, Pain, and Disability in Children With Chronic Pain: Is Affect a Mediator or Moderator?

Abstract

Sleep problems have been identified as a potential antecedent of chronic pain and pain-related disability in pediatric populations. In adult studies, affect has been implicated in these relationships. This study sought to better understand the relationships between sleep quality, negative and positive affect and pain and functioning in children with chronic pain. Participants included 213 children and adolescents (aged 7–17) presenting to a tertiary pain clinic with chronic pain. Children completed questionnaires measuring sleep quality, positive and negative affect, pain intensity, and functional disability. Results indicated that 74% of children reported disordered sleeping and that poor sleep quality was significantly associated with increased pain, disability, negative affect, and decreased positive affect. Our hypotheses were partially supported, with negative affect (but not positive affect) mediating the relationship between poor sleep and increased pain; and both positive and negative affect mediating the relationship between poor sleep and increased functional disability. There was no evidence for affect as a moderator. This study adds to the growing literature demonstrating the impact of poor sleep quality on children’s pain and functioning, highlighting the need to develop further longitudinal research to confirm the causal roles of these variables.

Factors influencing risk‐based care of the childhood cancer survivor in the 21st century

“…Although the presence of chronic pain (ie, persistent or recurrent pain lasting >3 months) has not been examined among adult survivors of childhood cancer, in the general population, chronic pain affects 10% to 11% of adults and is associated with depression, anxiety, decreased activity, and increased disability . Pain has also been associated with sleep problems and subsequent fatigue in the general population . During adulthood, long‐term survivors of childhood cancer frequently report poor sleep quality and fatigue, although at levels that are not substantially different from those in siblings .…”

Evaluation and Treatment of Children and Adolescents With Excessive Daytime Sleepiness

“…Other conditions affecting sleep (eg, chronic pain, nocturnal seizures, and prescription and/or illicit drugs) are important contributors in some children, as reviewed elsewhere. 2,[12][13][14][15][16][17] Untreated pediatric sleep problems and associated EDS may lead to behavioral problems, mood disturbances, depression, dysregulation of affect/emotion, impairments in neurocognitive function, increased risk for alcohol and drug use in teenagers, declining academic performance, and safety concerns. [18][19][20] Long-term chronic sleep loss, which results in EDS, adversely affects physiologic systems such as carbohydrate metabolism and endocrine function, potentially increasing risk for type 2 diabetes and cardiovascular dysfunction, with associated hypertension/risk of atherosclerosis and proinflammatory response.…”

Disentangling the Sleep-Pain Relationship in Pediatric Chronic Pain: The Mediating Role of Internalizing Mental Health Symptoms

“…Sleep problems in childhood (age 10-11 years; [ 15 ]) and young adulthood (age 19 years; [ 16 ]) were associated with a higher risk of developing pain problems two to three years later [ 15 , 16 ]. Few studies have empirically examined the mechanisms underlying the sleep-pain relationship in youth; however, negative affect [ 17 ] and depressive symptoms [ 18 ] have been proposed as potential mechanisms underlying the association between sleep impairments and increased pain intensity. In a sample of youth with chronic pain, lower positive affect and increased negative affect were shown to mediate the relationship between self-reported poor sleep quality and increased functional disability [ 17 ].…”