Positive affect and pain: mediators of the within-day relation linking sleep quality to activity interference in fibromyalgia.
Positive affect and pain: mediators of the within-day relation linking sleep quality to activity interference in fibromyalgia.
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DOI：
10.1097/01.j.pain.0000460324.18138.0a
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发表时间：
2015-03
期刊：
影响因子：
7.4
通讯作者：
Tennen HA
中科院分区：
文献类型：
--
作者：
Kothari DJ;Davis MC;Yeung EW;Tennen HA
纤维肌痛(FM)是一种慢性疼痛，通常会导致功能障碍。非恢复性睡眠是FM的一个与残疾有关的突出症状，但将前一晚的睡眠质量与第二天的残疾报告联系起来的日常机制尚未被研究。目前的研究考察了昨晚清晨关于睡眠质量的报告、上午晚些时候关于疼痛和积极和消极影响的报告以及一天结束时关于活动干扰的报告之间的日内关系。具体地说，我们测试了疼痛、积极情绪和负面情绪是否中介了睡眠质量和随后的活动干扰之间的关联。数据来自连续21天从220名FM患者收集的电子日记报告。采用多水平结构方程模型对直接效应和中介效应在人内水平进行了估计。结果表明，疼痛和积极情绪在睡眠质量与活动干扰之间起中介作用。昨晚早间关于睡眠质量不佳的报告预测，在上午晚些时候，疼痛水平会上升，积极情绪水平会降低，而这反过来又预示着一天结束时活动干扰的增加。值得注意的是，积极的情绪是比痛苦更强的中介，而负面的情绪不是显著的中介。总而言之，研究结果确定了两种平行的机制，疼痛和积极的情感，通过这两种机制，前一天晚上的睡眠质量预测FM患者第二天的残疾。此外，结果强调了在睡眠不佳后增强积极情绪的潜在效用，作为在FM中保持日常功能的一种手段。
Fibromyalgia (FM) is a chronic pain condition often resulting in functional impairments. Nonrestorative sleep is a prominent symptom of FM that is related to disability, but the day-to-day mechanisms relating the prior night’s sleep quality to next day reports of disability have not been examined. The current study examined the within-day relations among early-morning reports of sleep quality last night, late-morning reports of pain and positive and negative affect, and end-of-day reports of activity interference. Specifically, we tested whether pain, positive affect, and negative affect mediated the association between sleep quality and subsequent activity interference. Data were drawn from electronic diary reports, collected from 220 FM patients for 21 consecutive days. The direct and mediated effects at the within-person level were estimated with Multilevel Structural Equation Modeling. Results showed that pain and positive affect mediated the relation between sleep quality and activity interference. Early-morning reports of poor sleep quality last night predicted elevated levels of pain and lower levels of positive affect at late-morning, which, in turn, predicted elevated end-of-day activity interference. Of note, positive affect was a stronger mediator than pain, and negative affect was not a significant mediator. In summary, the findings identify two parallel mechanisms, pain and positive affect, through which the prior night’s sleep quality predicts disability the next day in FM patients. Further, results highlight the potential utility of boosting positive affect following a poor night’s sleep as one means of preserving daily function in FM.
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