Subjective Sleep Disruption and Mood Disorders are Associated with the Risk of Chronic Pain in Patients with Obstructive Sleep Apnea

Figures & data

Table 1 Demographic and Clinical Characteristics of OSA with and without Chronic Pain

	All OSA Patients (N = 145)	OSA without Chronic Pain (n = 90)	OSA with Chronic Pain (n = 55)	p	Effect Size Cohen’s d/h
Age, years	49.9 ± 11.2	49.3 ± 11.4	50.8 ± 10.8	0.460	0.13
Female, n (%)	52 (35.9)	27 (30)	25 (45.5)	0.060^	0.32
BMI, kg/m^2	24.7 [22.9, 27]	24.5 [22.9, 26.4]	24.7 [21.7, 27.3]	0.839	−0.06
Education level, college and above, n (%)	78 (53.8)	56 (62.2)	22 (40)	0.009**	−0.45
Tea (≥3 times/week), n (%)	46 (31.7)	31 (34.4)	15 (27.3)	0.368	−0.16
Alcohol (≥3 times/week), n (%)	12 (8.3)	9 (10)	3 (5.5)	0.514	−0.04
Smoking (≥3 times/week), n (%)	31 (21.4)	17 (18.9)	14 (25.5)	0.349	0.16
Comorbidities, n (%)
Hypertension	32 (22.1)	21 (23.6)	11 (20.4)	0.654	−0.08
Diabetes mellitus	8 (5.5)	5 (5.7)	3 (5.6)	1	−0.14
Heart diseases	9 (6.2)	5 (5.7)	4 (7.4)	0.956	0.24
Mood symptoms
HAMD score	8 [3, 12]	5.5 [2, 10]	10 [7, 14]	<0.001***	3.01
HAMA score	11.5 [7.8, 18]	10 [7, 16.5]	16.5 [12.3, 21.5]	0.018*	1.55
Pain measures
VAS	0 [0, 3]	0 [0, 0]	4 [2, 5]	<0.001***	3.00
PRI	0 [0, 3]	0 [0, 0]	3 [2, 7]	<0.001***	2.62
PPI	0 [0, 2]	0 [0, 0]	2 [1, 3]	<0.001***	0.71
SF-MPQ total score	0 [0, 8]	0 [0, 0]	10 [6, 15]	<0.001***	0.68

Notes: Continuous data are given as mean ± SD or median [interquartile range] as appropriate. ^p < 0.1; *p < 0.05; **p < 0.01; ***p < 0.001. The bold value means a statistically significant difference.

Abbreviations: HAMA, Hamilton Anxiety Rating Scale; HAMD, Hamilton Depression Rating Scale; OSA, Obstructive Sleep Apnea; PPI, Present Pain Intensity; PRI, Pain Rating Index; SD, Standard Deviation; SF-MPQ, Short-Form McGill Pain Questionnaire; VAS, Visual Analogue Scale.

Table 2 Subjective and Objective Sleep Parameters of OSA with and without Chronic Pain

	All OSA Patients (N = 145)	OSA without Chronic Pain (n = 90)	OSA with Chronic Pain (n = 55)	p	Effect Size Cohen’s d/h
Subjective sleep parameters
PSQI	8 [5, 14]	6 [4, 11]	12 [7, 16]	˂0.001***	0.65
PSQI > 5, n (%)	94 (64.8)	51 (56.7)	43 (78.2)	0.008**	0.47
ISI	10 [2, 16.5]	7 [2, 14]	19 [13, 22.4]	0.008**	0.44
8 ≤ ISI ≤ 14, n (%)	41 (28.3)	25 (27.8)	16 (29.1)	0.865	0.03
ISI > 14, n (%)	44 (30.3)	19 (21.1)	25 (45.5)	0.002**	0.52
ESS	6 [2, 11]	7 [2, 12]	5 [2,10]	0.587	−0.10
ESS > 10, n (%)	39 (26.9)	27 (30)	12 (21.8)	0.281	−0.19
Objective sleep parameters
Total sleep time, min	425.8 [372, 467.3]	416.3 [357.6, 459.5]	439.6 [392.9, 482.3]	0.073^	0.23
Sleep efficiency, %	84.6 [73.6, 91.3]	81 [70.6, 89.7]	86.5 [77, 93.4]	0.106	0.21
Sleep latency, min	10.3 [4.4, 22.6]	10.5 [5.8, 23.9]	10.3 [4, 10.2]	0.522	0.07
Stage N1, %	27.8 [19.3, 35.4]	28 [20.5, 39.6]	23.8 [17.4, 35.1]	0.221	−0.30
Stage N2, %	52.4 [42.2, 60.6]	51.7 [40.1, 60.5]	53.7 [43.5, 60.7]	0.365	0.25
Stage N3, %	0.1 [0, 2.6]	0 [0, 1.7]	0.4 [0, 3.6]	0.266	−0.05
Stage REM, %	17.5 [12.7, 21.5]	16.9[12.7, 20.6]	19.1 [12.7, 22.8]	0.229	0.22
Arousal index, /h	21.4 [14.1, 30.4]	22 [15.9, 30.4]	20.8 [12.4, 30.5]	0.313	−0.19
AHI, /h	28.3 [13.8, 57.1]	32.8 [16.5, 61]	19.7 [10.6, 46.1]	0.080^	−0.26
Minimum SaO2, %	83 [76.8, 88]	81.5 [76.0, 87]	84 [78.3, 88]	0.422	−0.08
PLMI, /h	0.4 [0.1, 1.5]	0.2 [0, 2.1]	0.5 [0.1, 1.6]	0.501	−0.13

Notes: Continuous data are given as mean ± SD or median [interquartile range] as appropriate. ^p < 0.1; **p < 0.01; ***p < 0.001. The bold value means a statistically significant difference.

Abbreviations: AHI, Apnoea–Hypopnoea Index; ESS, Epworth Sleepiness Scale; ISI, Insomnia Severity Index; OSA, Obstructive Sleep Apnea; PLMI, Periodic Limb Movement Index; PSQI, Pittsburgh Sleep Quality Index; REM, Rapid Eye Movement; SaO₂, Arterial Oxygen Saturation; SD, Standard Deviation.

Table 3 Associations of Mood Symptoms, Subjective and Objective Sleep Parameters with the Risk of Chronic Pain

	Unadjusted Models				Adjusted Models^§
	OR	Lower 95% CI	Upper 95% CI	p	AOR	Lower 95% CI	Upper 95% CI	p
Mood symptoms
HAMD	1.12	1.05	1.19	<0.001***	1.11	1.04	1.18	0.002**
HAMA	1.08	1.01	1.16	0.032*	1.09	1.01	1.17	0.033*
Subjective sleep parameters
PSQI	1.13	1.06	1.21	<0.001***	1.12	1.04	1.20	0.003**
ISI	1.06	1.01	1.10	0.013*	1.05	1.01	1.11	0.031*
ESS	0.98	0.92	1.04	0.553	0.99	0.93	1.06	0.773
Objective sleep parameters
Total sleep time, min	1.00	1.00	1.01	0.248	1.00	1.00	1.01	0.175
Sleep efficiency, %	1.01	0.99	1.04	0.29	1.02	0.99	1.05	0.204
Sleep latency, min	1.00	0.99	1.02	0.702	1.00	0.98	1.01	0.700
Stage N1, %	0.98	0.95	1.01	0.129	0.98	0.95	1.01	0.183
Stage N2, %	1.02	0.99	1.05	0.212	1.02	0.99	1.05	0.284
Stage N3, %	0.99	0.90	1.08	0.811	1.00	0.91	1.10	0.937
Stage REM, %	1.03	0.97	1.10	0.273	1.03	0.97	1.10	0.353
Arousal index, /h	0.99	0.96	1.01	0.345	0.99	0.97	1.02	0.657
AHI, /h	0.99	0.97	1.01	0.18	1.00	0.98	1.01	0.566
Minimum SaO2, %	0.99	0.96	1.03	0.673	0.97	0.93	1.01	0.193
PLMI, /h	0.89	0.57	1.38	0.596	0.88	0.54	1.41	0.583

Notes: ^§Models controlled for age, sex, BMI, and education level. *p < 0.05; **p< 0.01; ***p< 0.001. The bold value means a statistically significant association.

Abbreviations: AHI, Apnoea–Hypopnoea Index; AOR, Adjusted Odds Ratio; CI, Confidence Interval; ESS, Epworth Sleepiness Scale; HAMA, Hamilton Anxiety Rating Scale; HAMD, Hamilton Depression Rating Scale; ISI, Insomnia Severity Index; OSA, Obstructive Sleep Apnea; PLMI, Periodic Limb Movement Index; PSQI, Pittsburgh Sleep Quality Index; REM, Rapid Eye Movement; SaO₂, Arterial Oxygen Saturation.

Table 4 Associations of Mood Symptoms, Subjective and Objective Sleep Parameters with Pain Intensity^†

	Unadjusted Models					Adjusted Models^§
	Non-Standardized Coefficients		Standardized Coefficients			Non-Standardized Coefficients		Standardized Coefficients
	B	Standard Error	Beta	t	p	B	Standard Error	Beta	t	p
Mood symptoms
HAMD	0.14	0.03	0.36	4.60	<0.001***	0.15	0.03	0.37	4.36	<0.001***
HAMA	0.08	0.03	0.38	3.00	0.004**	0.08	0.03	0.37	3.11	0.003**
Subjective sleep parameters
PSQI	0.14	0.04	0.29	3.64	<0.001***	0.14	0.04	0.29	3.39	0.001**
ISI	0.05	0.03	0.17	2.02	0.045*	0.06	0.03	0.18	2.14	0.034*
ESS	−0.03	0.04	−0.07	−0.78	0.435	−0.02	0.04	−0.04	−0.39	0.696
Objective sleep parameters
Total sleep time, min	0.00	0.00	0.13	1.33	0.186	0.01	0.00	0.14	1.49	0.140
Sleep efficiency, %	0.02	0.02	0.11	1.10	0.275	0.02	0.02	0.12	1.27	0.207
Sleep latency, min	0.00	0.01	0.00	0.01	0.993	−0.01	0.01	−0.07	−0.71	0.482
Stage N1, %	−0.02	0.02	−0.14	−1.51	0.134	−0.02	0.02	−0.13	−1.31	0.194
Stage N2, %	0.02	0.02	0.09	0.92	0.361	0.02	0.02	0.11	1.1	0.272
Stage N3, %	0.03	0.06	0.04	0.46	0.647	0.06	0.06	0.1	0.98	0.331
Stage REM, %	0.05	0.04	0.12	1.30	0.197	0.05	0.04	0.12	1.18	0.240
Arousal index, /h	−0.02	0.02	−0.14	−1.47	0.143	−0.02	0.02	−0.12	−1.18	0.240
AHI, /h	−0.02	0.01	−0.18	−1.85	0.068^	−0.01	0.01	−0.13	−1.23	0.220
Minimum SaO2, %	0.01	0.02	0.04	0.46	0.650	−0.01	0.03	−0.02	−0.2	0.844
PLMI, /h	−0.17	0.30	−0.07	−0.58	0.566	−0.15	0.28	−0.06	−0.54	0.589

Notes: ^†Pain intensity was measured by a visual analog scale (VAS). ^§Models controlled for age, sex, BMI, and education level. ^p < 0.1; *p < 0.05; **p < 0.01; ***p < 0.001. The bold value means a statistically significant association.

Abbreviations: AHI, Apnoea–Hypopnoea Index; ESS, Epworth Sleepiness Scale; HAMA, Hamilton Anxiety Rating Scale; HAMD, Hamilton Depression Rating Scale; ISI, Insomnia Severity Index; OSA, Obstructive Sleep Apnea; PLMI, Periodic Limb Movement Index; PSQI, Pittsburgh Sleep Quality Index; REM, Rapid Eye Movement; SaO₂, Arterial Oxygen Saturation.