title: Longitudinal course and impact of insomnia symptoms in adolescents with and without chronic pain.
abstract: This study aimed to 1) examine trajectories of insomnia symptoms in adolescents with chronic pain compared to their healthy peers; 2) evaluate psychological and behavioral risk factors for longitudinal insomnia symptoms; and 3) evaluate insomnia as a predictor of quality of life, activity limitations, and healthcare utilization over 12 months. Participants included 61 adolescents with chronic pain and 60 youths without chronic pain (12-18 years; 72% female). Questionnaires were completed at enrollment, 6 months, and 12 months and assessed pain intensity, insomnia symptoms, sleep hygiene, presleep arousal, depression, pubertal status, activity limitations, quality of life, and healthcare utilization. Insomnia symptoms persisted for both groups and remained higher at all time points for youths with chronic pain. Generalized estimating equations modeling identified 3 risk factors for longitudinal insomnia symptoms: having chronic pain, poorer sleep hygiene, and higher depressive symptoms. Insomnia symptoms also predicted poorer quality of life over time and were associated with more frequent healthcare utilization. Findings suggest that sleep problems are persistent and associated with negative impact for youths with chronic pain. Treatment of insomnia symptoms in youths with chronic pain may lead to improvements in quality of life and reductions in healthcare costs.
  
  
  CONCLUSIONS
  Insomnia symptoms are persistent over a 12-month period and are associated with negative impact for youths with chronic pain. These findings suggest that treatment of insomnia symptoms in youths with chronic pain may lead to improvements in quality of life and reductions in healthcare costs.
authors.affiliation: University of Washington and Seattle Children's Research Institute, Seattle, WA 98145, USA. tonya.palermo@seattlechildrens.org
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Palermo
authors.forename: Emily
authors.initials: E
authors.lastname: Law
authors.forename: Shervin S
authors.initials: SS
authors.lastname: Churchill
authors.forename: Amy
authors.initials: A
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D001143:Arousal / Q000502:physiology; D002648:Child; D059350:Chronic Pain / Q000150:complications / Q000523:psychology*; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003710:Demography; D003863:Depression / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D009043:Motor Activity / Q000502:physiology; D010147:Pain Measurement; D011627:Puberty / Q000502:physiology; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires; D014851:Wakefulness