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An actigraphy study of sleep and pain in midlife women

the Study of Women’s Health Across the Nation Sleep Study

Kravitz, Howard M. DO, MPH1,2; Zheng, Huiyong PhD3; Bromberger, Joyce T. PhD4,5; Buysse, Daniel J. MD5; Owens, Jane DrPH5; Hall, Martica H. PhD5

doi: 10.1097/GME.0000000000000379
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Objective We examined whether women reporting nighttime pain would have more actigraphy-measured evidence for disturbed sleep and would report feeling less rested compared with women without nighttime pain.

Methods Up to 27 consecutive nights of actigraphy and sleep diary data from each participant were analyzed in this community-based study of 314 African-American (n = 118), white (n = 141), and Chinese (n = 55) women, aged 48 to 58 years, who were premenopausal, perimenopausal, or postmenopausal and were participating in the Study of Women’s Health Across the Nation Sleep Study. Dependent variables were actigraphy-measured movement and fragmentation index, total sleep time, sleep efficiency, and diary self-report of “feeling rested” after waking up. All outcomes were fitted using linear mixed-effects models to examine covariate-adjusted associations between the independent variable (nighttime pain severity) and sleep outcomes.

Results Higher pain severity scores were associated with longer sleep duration but reduced sleep efficiency and less restful sleep. Women reporting nocturnal vasomotor symptoms had more sleep-related movement and sleep fragmentation, had reduced sleep efficiency, and were less likely to feel rested after wakening whether or not they reported pain.

Conclusions Midlife women who report higher nighttime pain levels have more objective evidence for less efficient sleep, consistent with self-reported less restful sleep. Nocturnal vasomotor symptoms also can contribute to restlessness and wakefulness in midlife women.

From the 1Department of Psychiatry, Rush University Medical Center, Chicago, IL; 2Department of Preventive Medicine, Rush University Medical Center, Chicago, IL; 3Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI; 4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and 5Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Received July 8, 2014; revised and accepted September 23, 2014.

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging, National Institute of Nursing Research, Office of Research on Women’s Health, or National Institutes of Health. This study was not industry-supported. There were no off-label or investigational uses of medications or technologies.

This article was presented in part at the 21st Annual Meeting of The North American Menopause Society, Chicago, IL, October 8, 2010, and published in abstract form [Kravitz HM, Carlson K, Sowers MF, et al. An actigraphy study of sleep and pain during the menopausal transition: the SWAN Sleep Study [Abstract S-13]. Menopause 2010;17:1219].

Funding/support: The Study of Women’s Health Across the Nation received grant support from the National Institutes of Health, Department of Health and Human Services, through the National Institute on Aging, National Institute of Nursing Research, and National Institutes of Health Office of Research on Women’s Health (grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, and U01AG012495). Funding for the Study of Women’s Health Across the Nation Sleep Study was provided by the National Institute on Aging (grants R01AG019360, R01AG019361, R01AG019362, and R01AG019363). Sleep data were processed with the support of grant RR024153.

Financial disclosure/conflicts of interest: None of the work was supported by commercial sources. D.J.B. serves as a paid consultant for Eisai, Merck, Otsuka, Emmi Solutions, Medscape, and CME Outfitters. Consulting fees for each company are less than US$5,000 annually. D.J.B. has been paid for and lectures at non-CME educational meetings supported by Servier and Astellas. The other authors have no relevant financial conflicts of interest to disclose.

Address correspondence to: Howard M. Kravitz, DO, MPH, Department of Psychiatry, Rush University Medical Center, Rush West Campus, 2150 West Harrison Street, Chicago, IL 60612. E-mail: hkravitz@rush.edu

© 2015 by The North American Menopause Society.