Samuel Silva

Introduction: Sleep disorders and chronic low back pain (CLBP) are prevalent conditions in older adults and can coexist in a bidirectional relationship. The aim was to investigate the associations between the risk of obstructive sleep apnoea (OSA), excessive daytime sleepiness, sleep quality with pain intensity and functional disability, and to estimate the prevalence of sleep complaints in older adults with CLBP. Materials and methods: A cross-sectional study involving older adults with CLBP aged 60 years and above from primary care was conducted. Data collected included OSA risk (Berlin Questionnaire), excessive daytime sleepiness (Epworth Sleepiness Scale), sleep quality (Pittsburgh Sleep Quality Index), pain intensity (Numerical Pain Rating Scale), functional disability (Roland–Morris Questionnaire) and sleep complaints (Sleep Complaints Questionnaire). We performed descriptive analyses and ran six univariate and multivariable linear regression models (adjusted for potential confounders). Results: Sleep quality was associated with disability, even after adjusting for confounders (0.25 [CI 95%: 0.07–0.43]). Sleep quality was also significantly associated with pain intensity (0.28 [CI 95%: 0.09–0.47]) in univariate analysis. The risk of OSA was associated with pain intensity (0.30 [CI 95%: 0.16–0.72]) and functional disability (0.33 [CI 95%: 0.20–0.75]), but only in univariate analysis. Excessive daytime sleepiness and pain intensity were negatively associated in a multivariable analysis (−0.21 [CI 95%: −0.42, to 0.01]). A prevalence of at least one sleep complaint was found in 96% of participants. Conclusions: Poor sleep quality was associated with disability, and pain intensity appeared to worsen sleep. Routine screening and interventions for sleep problems could help reduce pain, disability and healthcare burden.

Background/Objectives: Sleep seems to be associated with worse low back pain (LBP) outcomes in older adults; however, studies investigating the association of objective sleep with future changes in LBP outcomes are lacking. The objectives of this study are as follows: (a) to investigate the association between objectively measured sleep with changes in clinical outcomes in older adults with LBP receiving physical therapy care and (b) to examine the cross-sectional association between sleep and pain catastrophizing. Methods: This was a prospective cohort study. We recruited older adults (≥60 years old) with chronic LBP undergoing physical therapy treatment. At baseline, we assessed participants’ sleep (actigraphy for 10–14 days), pain intensity, disability, pain catastrophizing, and covariates. After 8 weeks, we reassessed pain intensity, disability, and self-perceived recovery. We ran linear regression models and Spearman coefficient tests. Results: Fifty-eight participants were included, and 51 completed follow-up assessments (60.8% women; mean age 70.1 ± 5.6 years). We found no associations between sleep quantity and efficiency with changes in pain intensity, disability, and self-perceived recovery after 8 weeks of physical therapy care. We found a correlation between sleep fragmentation and pain catastrophizing (r = .30; 95% confidence interval: [.03, .54]). Conclusion: Objective sleep quantity and efficiency may not be associated with changes in LBP outcomes after physical therapy care in older adults. Among the sleep domains evaluated, sleep fragmentation may be the sleep domain with the strongest association with pain catastrophizing. Significance/Implications: Objectively measured sleep might not be a prognostic factor for LBP improvement in older adults. Future studies should explore the association between sleep fragmentation and pain catastrophizing.

Context: Understanding Paralympic athletes’ perspectives on the importance of sleep is the first step toward developing effective sleep hygiene (SH) strategies. We aim to describe and compare the knowledge about SH and sleep behaviors practiced by medalists and nonmedalists Paralympic athletes at the Tokyo 2020 Paralympic Games and between sexes (female vs male), identify whether the coaching staff encourages SH, and the perspective of these athletes on the importance of SH. Methods: 98 Paralympic athletes responded to the Sleep Beliefs Scale and the Athlete Sleep Behavior Questionnaire-BR. Results: Medalists (68%) and nonmedalists (78%) Paralympic athletes had low knowledge about SH (60% vs 55%; P = .20), with no difference between groups. The Athlete Sleep Behavior Questionnaire-BR score (48.7 [5.9]) for all Paralympic athletes (n = 98) indicated high practice of maladaptive sleep behaviors. Male athletes had significantly worse sleep behaviors than female athletes (49.1 [6.0] vs 39.5 [7.2]; P < .01) and less knowledge about behaviors that can affect sleep (64% vs 72%; P < .05), 26% of Paralympic athletes considered SH practices necessary, and the frequency of coaching staff encouraging SH was higher among medalists Paralympic athletes compared to nonmedalists athletes (29% vs 13%, P = .04). Conclusions: Most Paralympic athletes have inadequate sleep behaviors and knowledge about SH. There was no difference between knowledge about SH and sleep behaviors between medalists and nonmedalists Paralympic athletes, although medalists athletes were more encouraged to practice SH. Male Paralympic athletes had worse sleep behaviors and worse knowledge about SH than female athletes.

HIGHLIGHTS Menstrual flow intensity is proportional to menstrual pain intensity. Women with regular menstrual cycles tend to experience more menstrual pain. Physiotherapy can be an excellent alternative to reduce menstrual pain.

HIGHLIGHTS Menstrual flow intensity is proportional to menstrual pain intensity. Women with regular menstrual cycles tend to experience more menstrual pain. Physiotherapy can be an excellent alternative to reduce menstrual pain.

Sleep problems are common in individuals with low back pain (LBP) and sleep restriction seems to be associated with impaired pain processing. Our objective was to investigate whether sleep is associated with future LBP outcomes (i.e. pain intensity, disability, and recovery) in adults. We conducted a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials (registration—PROSPERO CRD42022370781). In December 2022, we searched the MEDLINE, Embase, CINAHL, and PsycINFO databases. Fourteen studies, totaling 19 170 participants were included. Thirteen studies were rated as having high risk of bias (QUIPS tool). We used vote-counting and meta-analysis approaches to synthesize the data. We found associations between baseline sleep with future pain intensity, recovery, and between changes in sleep with changes in pain intensity, changes in disability, and recovery. We further synthesized outcomes as “overall LBP improvement” outcomes. Baseline poor sleep was moderately associated with non-improvement in LBP in the long-very long term (OR 1.55, 95% CI: 1.39 to 1.73; three studies providing unadjusted effect sizes), and non-improvement in sleep was largely associated with non-improvement in LBP in the short-moderate term (OR 3.45, 95% CI: 2.54 to 4.69; four studies providing unadjusted effect sizes). We found no association between baseline sleep with future disability and overall LBP improvement in the short-moderate term. Therefore, sleep may be a prognostic factor for pain intensity and recovery from LBP. All findings were supported by low to very low-quality evidence. Better-conducted studies are needed to strengthen our certainty about the evidence.