title: Sleep and daytime sleepiness problems among patients with chronic noncancerous pain receiving long-term opioid therapy: a cross-sectional study.
abstract: OBJECTIVE
  Sleep problems are common among patients with chronic pain (CP). Information on sleep problems and associated covariates in opioid-treated patients with CP is limited. The aim of this study was to assess the prevalence, characteristics, and risk factors of sleep and daytime sleepiness problems in this specific population.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Primary care outpatient clinics.
  
  
  METHODS
  Eight hundred and seventy six patients with CP treated with long-term opioids.
  
  
  METHODS
  Prestudy selected questionnaires: six questions from the Medical Outcomes Study Sleep Scale, Pain Inventory Survey, Pain Patient Profile, Substance Dependence Severity Scale, and medication log.
  
  
  RESULTS
  Insomnia-type sleep problems and combined sleep and sleepiness problems were reported by 87 percent and 49 percent of the sample, respectively. Logistic regression analysis showed that depression (adjusted OR, aOR 2.8, 95% CI2.1-3.7) and pain severity (aOR 1.4, 95% CI 1.1-1.7) were the strongest independent predictors of sleep problems; only depression severity predicted daytime sleepiness (aOR 1.9, 95% CI 1.6-2.2) or combined sleep/sleepiness problems (aOR 2.2, 95% CI 1.8-2.5). Opioid dose was associated with a slight tendency toward unrefreshing sleep (aOR 1.2, 95% CI 1.0-1.4) and worse sleep maintenance (aOR 1.2, 95% CI 1.0-1.4), while use of long-acting opioids was associated with a trend toward increased napping (aOR 1.3, 95% CI 1.0-1.8).
  
  
  CONCLUSIONS
  Sleep and daytime sleepiness problems are common among opioid-treated primary care patients with CP and seem to be related mainly to depression and pain severity. Physicians caring for opioid-treated patients with CP may want to assess them for sleep disorders as a part of routine CP care.
authors.affiliation: Department of Family Medicine, University of Wisconsin, Madison, USA.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zgierska
authors.forename: Randall T
authors.initials: RT
authors.lastname: Brown
authors.forename: Megan
authors.initials: M
authors.lastname: Zuelsdorff
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.forename: Zhengjun
authors.initials: Z
authors.lastname: Zhang
authors.forename: Michael F
authors.initials: MF
authors.lastname: Fleming
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012890:Sleep / Q000187:drug effects*; D012893:Sleep Wake Disorders / Q000139:chemically induced / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D014922:Wisconsin
chemical_list: D000701:Analgesics, Opioid