title: Pain grade and sleep disturbance in older adults: evaluation the role of pain, and stress for depressed and non-depressed individuals.
abstract: OBJECTIVE
  The aim of this paper was to assess the relationship between pain and sleep in older adults taking depression, stress, and medical comorbidities into account.
  
  
  METHODS
  A cross-sectional analysis was performed using Einstein Aging Study, a community-based cohort study of adults aged 70 years and older. Ratings of pain intensity and interference from the Medical Outcomes Study (MOS) Short-Form 36 were used to assign individuals to low-pain versus high-pain severity. Sleep disturbance was assessed using the nine-item sleep problems index from the Medical Outcomes Study Sleep Scale. Other measures included the Geriatric Depression Scale and Perceived Stress Scale (PSS). Linear regression models were used to assess the association between pain grade and sleep disturbance adjusted for demographics, PSS, Geriatric Depression Scale, and other comorbidities.
  
  
  RESULTS
  Five hundred sixty-two eligible participants with a mean age of 78.22 years (standard deviation = 5.43) were included; 64% were women. Pain grade [β = 5.40, 95% confidence interval (CI) 2.56-8.21, p < 0.001] was associated with sleep disturbance after adjusting for demographic variables. In models including pain grade (β = 3.08, 95% CI 0.32-5.85, p = 0.03) and PSS (β = 0.57, 95% CI 0.39-0.75, p < 0.001), both were associated with sleep disturbance, although the PSS attenuated the relationship between pain and sleep by 34%. Depression, when added to previous model, was also associated with sleep (β = 2.17, 95% CI 1.48-2.85, p < 0.001) and attenuated the relationship between pain (β = 2.41, 95% CI -0.25 to 5.08, p = 0.07) and sleep by 22%. Stratified for depression, we found that pain, stress, and other medical comorbidities were significantly associated with sleep disturbance in non-depressed individuals but not individuals with depression.
  
  
  CONCLUSIONS
  Pain, stress, and medical comorbidities are associated with sleep disturbance, especially in non-depressed older adults.
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.|Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Vahid
authors.initials: V
authors.lastname: Eslami
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Zimmerman
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Trishdeep
authors.initials: T
authors.lastname: Grewal
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Mindy
authors.initials: M
authors.lastname: Katz
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010146:Pain / Q000150:complications* / Q000523:psychology; D011788:Quality of Life; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology*; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology
keywords: depression; pain intensity; pain interference; sleep problems index; stress