Chronic Pain, Sleep, and Cognition in Older Adults With Insomnia: A Daily Multilevel Analysis
Chronic Pain, Sleep, and Cognition in Older Adults With Insomnia: A Daily Multilevel Analysis
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DOI：
10.5664/jcsm.7392
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发表时间：
2018-01-01
影响因子：
4.3
通讯作者：
McCrae, Christina S.
中科院分区：
文献类型：
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作者：
Curtis, Ashley F.;Williams, Jacob M.;McCrae, Christina S.
研究目的：本研究的目的是考察有或没有慢性疼痛病史的失眠老年人的睡眠和认知之间的日常联系。方法：60名失眠和慢性疼痛病史的老年人(HxCP；n=33，平均年龄=69.5岁，标准差=7.8)或没有慢性疼痛病史(NCP；n=27，平均年龄=69.7岁，标准差=7.9)完成了14天的日记和活动，测量入睡潜伏期(SOL)、入睡后醒来(WASO)、睡眠效率(SE)和睡眠质量。参与者完成了日常认知测量，包括加工速度(即符号数字通道测试，SDMT)、推理(即字母序列)和言语记忆(即单词列表延迟回忆)。对于HxCP和NCP，通过多水平模型检验了睡眠参数、日常疼痛、抑郁症状(即Beck抑郁量表第二版评分)与日常认知、年龄控制和全局认知之间的关系。结果：对于HxCP，自我报告的WASO越大，次日SDMT成绩越差，而活动WASO越大，次日SDMT成绩越好。更严重的抑郁与较差的每日信件系列表现相关。自我报告的WASO和SE越大，第二天延迟回忆的效果就越好。对于NCP，自我报告的WASO和抑郁与较好的日常SDMT表现相关，而较差的日常疼痛与较差的SDMT和延迟回忆操作相关。结论：在患有HxCP的老年人中，改善睡眠可能有利于较低水平的认知，而减轻抑郁可能会影响较高水平的认知。在研究失眠对认知的影响时，睡眠参数的差异促进了对客观和主观睡眠结果的评估。
Study Objectives: The goal of this study was to examine daily associations between sleep and cognition in older adults suffering from insomnia, with or without a history of chronic pain.Methods: Sixty older adults with insomnia and a history of chronic pain (HxCP; n = 33, mean age = 69.5 years, standard deviation = 7.8) or no history of chronic pain (NCP; n = 27, mean age = 69.7 years, standard deviation = 7.9) completed 14 days of diaries and actigraphy, measuring sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), and sleep quality. Participants completed daily cognitive measures of processing speed (ie, symbol digit modalities test, SDMT), reasoning (ie, letter series), and verbal memory (ie, word list delayed recall). For HxCP and NCP, associations between sleep parameters, daily pain, depressive symptoms (ie, Beck Depression Inventory, Second Edition scores), and daily cognition, controlling for age, and global cognition were examined through multilevel modeling.Results: For HxCP, greater self-reported WASO was associated with worse next-day SDMT performance, whereas greater actigraphic WASO was associated with better next-day SDMT performance. Greater depression was associated with worse daily letter series performance. Greater self-reported WASO and SE were associated with better next-day delayed recall. For NCP, greater self-reported WASO and depression were associated with better daily SDMT performance, whereas worse daily pain was associated with worse SDMT and delayed recall performance.Conclusions: In older adults with HxCP, improving sleep may benefit lower level cognition, whereas reducing depression may affect higher level cognition. Discrepancies in sleep parameters promote assessment of objective and subjective sleep outcomes when investigating effects of insomnia on cognition.