Sleep, Pain, Active Social Life, and Inflammation (SPAI)

摘要 慢性疼痛是一种疾病的预后标志，给医疗保健系统带来了巨大的负担， 影响了大约20 - 30%的美国成年人。睡眠问题通常与慢性疼痛同时发生，但很少 睡眠对慢性疼痛的影响社会参与和炎症与两者都有关系 睡眠和慢性疼痛，但没有研究已经检查了这些行为和生物学机制的基础上， 睡眠对慢性疼痛的影响本R01启动了一项多队列研究，以检查 睡眠对慢性疼痛的影响由社会生活方式和炎症介导。在这项研究中，我们采取了睡眠健康 视角捕捉对慢性疼痛至关重要的多种睡眠特征（规律性，满意度，警觉性， 时间、效率和持续时间）。基于通过自我报告、体动记录和/或 多导睡眠图，我们将确定"睡眠健康概况"（睡眠问题或潜在睡眠问题的综合数量）， 在多个维度上具有相似睡眠特征的群体），并将其与慢性疼痛结果联系起来。 我们的睡眠概况方法具有优势，因为它可以考虑可能同时发生的多种睡眠问题 在个体内，并且可能差异性地影响疼痛结果。利用NIH资助的三个项目（中年 在美国研究-MIDUS，老年男性睡眠障碍的结局-MrOS，和多中心 Osteoarthritis Study-MOST），我们检查了成人人群中普遍存在的多种常见慢性疼痛状况 (any慢性疼痛、背痛和膝关节疼痛）及其多种表现（频率、严重程度和 致敏）。这可以帮助确定睡眠健康状况和慢性疼痛之间的联系 在不同的疼痛条件下出现。目标1将研究睡眠健康状况对 三种不同的疼痛结果的疼痛变化。我们假设睡眠不好 与：[MIDUS]任何慢性疼痛新发和/或疼痛干扰增加相关， 中年和老年人;[MrOS]新发背痛和/或背痛的频率和严重程度增加 老年男性疼痛;[MOST]老年男性膝关节疼痛严重程度和临床致敏性增加 随着时间的推移，男性/女性有患骨关节炎的风险。目标2将研究行为和生物机制 睡眠健康状况对疼痛变化的影响。我们假设睡眠不好 与由较低的社会活动多样性介导的随时间推移的更多慢性疼痛相关（即，较不活跃 社会生活）或全身性炎症的较高风险。目标3将审查下列因素的独立和联合影响： 睡眠健康状况对疼痛变化影响的行为和生物学机制。我们 多队列方法还使我们能够通过聚合来检测睡眠和慢性疼痛的潜在社会差异。 队列中的相关种族和性别亚组。该项目将为未来的行为干预提供信息（例如， 睡眠健康干预），通过识别特定的睡眠特征来改善成年人的慢性疼痛， 睡眠健康与慢性疼痛之间的行为和生物学机制。

Abstract Chronic pain is a prognostic marker of illness and imposes a substantial burden on the healthcare system, affecting approximately 20-30% of US adults. Sleep problems commonly co-occur with chronic pain, yet little is known of how sleep impacts chronic pain. Social engagement and inflammation have relationships with both sleep and chronic pain, but no study has examined these behavioral and biological mechanisms underlying the impact of sleep on chronic pain. This R01 initiates a multi-cohort study to examine the extent to which the impact of sleep on chronic pain is mediated by social lifestyles and inflammation. In this study, we take a sleep health perspective to capture multiple sleep characteristics critical to chronic pain (regularity, satisfaction, alertness, timing, efficiency, and duration). Based on multiple sleep variables captured by self-report, actigraphy, and/or polysomnography, we will identify “sleep health profiles” (the composite number of sleep problems or latent groups with similar sleep characteristics across multiple dimensions) and link them to chronic pain outcomes. Our sleep profile approach has advantages because it can consider multiple sleep problems that may co-occur within individuals, and may differentially impact pain outcomes. Leveraging three NIH-funded projects (Midlife in the United States Study-MIDUS, Outcomes of Sleep Disorders in Older Men-MrOS, and Multicenter Osteoarthritis Study-MOST), we examine multiple common chronic pain conditions prevalent in adult populations (any chronic pain, back pain, and knee pain) and their multiple manifestations (frequency, severity, and sensitization). This can help determine whether the associations between sleep health profiles and chronic pain emerge across different pain conditions. Aim 1 will examine the longitudinal impact of sleep health profiles on subsequent changes in pain for three separate pain outcomes. We hypothesize that poor sleep health profiles are associated with: [MIDUS] new onset of any chronic pain and/or an increase in pain interference among midlife and older adults; [MrOS] new onset of back pain and/or increases in the frequency and severity of back pain among older men; [MOST] increases in knee pain severity and clinical sensitization among older men/women with the risk of osteoarthritis over time. Aim 2 will examine behavioral and biological mechanisms underlying the impact of sleep health profiles on changes in pain. We hypothesize that poor sleep health profiles are associated with more chronic pain over time mediated by lower diversity in social activities (i.e., a less active social life) or by a higher risk of systemic inflammation. Aim 3 will examine independent and joint effects of behavioral and biological mechanisms underlying the impact of sleep health profiles on changes in pain. Our multi-cohort approach also allows us to detect potential social disparities in sleep and chronic pain by aggregating relevant racial and sex sub-groups across cohorts. This project will inform future behavioral interventions (e.g., sleep health intervention) to improve chronic pain in adults by identifying specific sleep characteristics, and key behavioral and biological mechanisms linking sleep health and chronic pain.