Sleep quality predicts functional disability in older adults with low back pain: a longitudinal study
By Priscila Kalil Morelhão
Due to the advancement of medicine, people are living increasingly longer. It is expected that Brazil will be the 6th country with the highest number of older people in 2025. However, living longer does not necessarily mean aging healthy and with quality of life. This is because there are many chronic diseases prevalent in the older population, such as low back pain. This is a common complaint in the Brazilian population. It is estimated that 25% of people have symptoms in Brazil, and the older you are, the greater the intensity of the pain. This comorbidity can modify the day-to-day life of those who feel it as it causes disabling effects. This means that these people may become more secluded, less active, and have greater difficulty carrying out activities of daily living. There are many reasons for this painful sensation, among them physical inactivity and muscle weakness. Furthermore, poor sleep quality is often reported in people with musculoskeletal pain.
The relationship between sleep and pain is bidirectional. People who sleep worse feel more pain the next day since poor sleep increases pain sensitivity. The opposite is also true, pain makes it impossible to sustain quality sleep. This vicious cycle culminates in unrefreshing sleep. Little is known about the relationship between sleep and disability in the elderly.
Just as all physiological functions decline over time, sleep is no different. What should we expect from sleep as we age? There are clear changes in nocturnal sleep time, such as the tendency to increase awake time; daytime sleep tends to increase, which leads to the belief that many elderly people have a total sleep time - greater than 8 hours over the course of 24 hours. This can be harmful because it reduces the ability to engage in physical and mental activity during the day and the opportunity for more adequate nocturnal slow-wave sleep. This mechanism is fundamental for the regulation of bone, glucose, and muscle metabolism, and for hormonal regulation. REM sleep tends to have a slight decrease, but it can still have an important impact in cognitive and emotional processing.
It is possible that these age-related particularities interfere with the relationship between sleep and pain. However, it is not known whether poor sleep has a prognostic relationship with functional disability in cases of chronic pain. Our hypothesis was that older adults with low back pain and poor sleep would develop more disability after 6 months than those who sleep well.
To obtain this answer, the researchers conducted home interviews with Brazilians over 60, without cognitive impairment, with symptoms of chronic low back pain exceeding 12 weeks. In the first contact, data regarding sleep quality using Pittsburgh Sleep Quality Index, and functional disability using Roland Morris Disability Questionnaire were collected. After 6 months, the participants were contacted by telephone and answered these questionnaires again. When analyzing the data, it was noticed that older people who slept poorly at baseline had greater disability after 6 months. These results confirmed our hypothesis and support the existence of an important relationship between sleep and disability in older adults with low back pain.
Article Details
Sleep Quality Predicts Functional Disability in Older Adults with Low Back Pain: A Longitudinal Study
Sabrina Dias Oliveira, Rafael Z. Pinto, Cynthia Gobbi, Guilherme L. Fernandes, Vinícius Dokkedal-Silva, Ítalo Ribeiro Lemes, Monica L. Andersen, Sergio Tufik, Roselene Modolo Regueiro Lorenconi, and Priscila K. Morelhão
First published online July 15, 2022
DOI: 10.1177/07334648221113500
Journal of Applied Gerontology
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