Anxiety and Depression as Mediators of the Sleep–Pain Relationship in Youth Presenting for Polysomnography

Abstract

Objective: The sleep–pain relationship in youth is well established; however, little is known about the mechanisms underlying this relationship, particularly in at-risk groups (i.e., youth with sleep problems). Youth with sleep concerns, and those with chronic pain, often experience more internalizing problems compared to their healthy counterparts. The current study aims to explore anxiety and depression as mediators of the sleep–pain relationship in youth presenting for polysomnography. Methods: School age (n = 114, 6–11 years) and adolescent participants (n = 100, 12–18 years) were included. Youth completed the Epworth Sleepiness Scale and PROMIS scales for anxiety, depression, and pain experience. The Pediatric Insomnia Severity Index was completed by adolescents and via parent proxy for school age youth. Sleep efficiency was gathered via overnight polysomnography. Results: Multiple mediation analyses indicate that for adolescents, increased insomnia severity is associated with increased pain experience through the indirect effects of greater symptoms of anxiety and depression (ps < .05), although these relationships were not significant for school age youth (ps > .05). For both age groups, increased subjective sleepiness was associated with greater pain experience through the indirect effects of increased symptoms of depression (p < .05). There was no direct or indirect relationship between objective sleep efficiency and pain in either group (p > .05). Conclusions: Greater symptoms of depression may explain the sleep–pain relationship in youth with sleep problems, while greater anxiety appears to impact this relationship primarily among older youth. Addressing these symptoms within the context of sleep treatment may prevent/alleviate pain.

Implications for Impact Statement

Among youth, sleep and pain are related to one another, such that poor sleep may lead to an increase in pain experiences, and vice versa. The factors that maintain this relationship are less understood. This study found symptoms of depression may indirectly affect this relationship in childhood and into adolescence, and symptoms of anxiety may indirectly affect this relationship among adolescents. These findings may inform screening for symptoms and treatment recommendations.