Sleep Disturbance and Depression Symptoms Mediate Relationship Between Pain and Cognitive Dysfunction in Lupus
Sleep Disturbance and Depression Symptoms Mediate Relationship Between Pain and Cognitive Dysfunction in Lupus
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DOI：
10.1002/acr.23593
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发表时间：
2019-03-01
影响因子：
4.7
通讯作者：
Jolly, Meenakshi
中科院分区：
文献类型：
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作者：
Lillis, Teresa A.;Tirone, Vanessa;Jolly, Meenakshi
目的探讨系统性红斑狼疮（SLE）患者的睡眠障碍和抑郁症状是否介导了疼痛与认知功能障碍（CD）的关系。方法对115例SLE患者进行疼痛、压力感受、抑郁、睡眠和CD问卷调查。疼痛，睡眠，抑郁症和CD之间的关系进行了评估，使用引导中介模型，控制种族/民族，纤维肌痛诊断，目前皮质类固醇的使用，疾病活动和损害，和感知的压力。结果中介效应分析显示，疼痛对CD的影响是由睡眠障碍（β = 0.30）和抑郁症状（β = 0.33）介导的。即使在控制了上述协变量后，这些效应仍得以维持，其中只有疾病活动（β = 0.20）和应激（β = 0.22）仍与CD显著相关（总体模型R-2 = 0.53;所有P < 0.05）。结论在控制疾病活动性和自觉压力后，疼痛与CD的关系可以用睡眠障碍和抑郁症状来解释。虽然这些关系需要验证纵向研究与其他测量方式，我们的研究结果可能表明有前途的，非药物干预途径的SLE患者疼痛和CD。具体来说，已知抑郁症和睡眠的认知行为疗法可以减少痛苦并增强各种心理社会领域的功能。鉴于SLE的症状负担，在不使用额外药物治疗的情况下最大化潜在益处的干预措施可能特别有用。
Objective To determine whether sleep disturbance and symptoms of depression mediate the relationship between pain and cognitive dysfunction (CD) in a sample of 115 patients with systemic lupus erythematosus (SLE). Methods A total of 115 patients with SLE completed questionnaires regarding pain, perceived stress, depression, sleep, and CD. Relationships among pain, sleep, depression, and CD were assessed using bootstrap mediation models, controlling for race/ethnicity, fibromyalgia diagnosis, current corticosteroid use, disease activity and damage, and perceived stress. Results Mediation analyses indicated that the effect of pain on CD was mediated by sleep disturbance (beta = 0.30) and depression symptoms (beta = 0.33). These effects were maintained even after controlling for the aforementioned covariates, of which only disease activity (beta = 0.20) and stress (beta = 0.22) remained significantly linked to CD (overall model R-2 = 0.53; all P < 0.05). Conclusion After controlling for disease activity and perceived stress, the relationship between pain and CD was explained by sleep disturbance and depression symptoms. Although these relationships need validation in longitudinal studies with additional measurement modalities, our findings may indicate promising, nonpharmacologic intervention avenues for SLE patients with pain and CD. Specifically, cognitive behavioral therapies for depression and sleep are known to reduce distress and enhance functioning across various psychosocial domains. Given the symptom burden of SLE, interventions that maximize potential benefits without the use of additional pharmacologic treatments may be of particular utility.