Pain due to musculoskeletal problems (such as osteoarthritis) has been shown to have a significant negative impact on sleep quality. In turn, both poor sleep quality and pain affect physical activity, likely restricting behaviour (movement), improving symptoms and quality of life in this patient group. However, the exact relationship between these three aspects has received limited attention. This lack of understanding means that we are unable to design interventions and provide targeted advice to encourage sleep and activity in patients experiencing pain associated with musculoskeletal problems.
This work extended a longitudinal cohort study in community-dwelling men. These participants have undertaken in-home sleep studies, and this study added musculoskeletal and physical activity data collection to determine the relationship between sleep, musculoskeletal pain and physical activity. The collection of comprehensive sleep data (using polysomnography) is expensive and time-consuming and is seldom performed in community samples. Therefore, this was a unique opportunity to improve further our understanding of sleep, musculoskeletal pain and physical activity. Through the addition of questions in a questionnaire and wearing a watch-like device on the wrist, we could get a more complete picture of how sleep, pain, and activity work together.
This project aimed to provide an improved understanding of the relationship between sleep, pain, and physical activity. Suppose the relationship between these factors is more precisely defined. In that case, it can lead to better designed, targeted interventions (precision care) to improve the management of patients living with pain associated with musculoskeletal conditions. There is the potential to increase activity, which is beneficial for musculoskeletal disorders and to improve sleep. If there are improvements in sleep, pain levels may also improve. These benefits would then improve the quality of life of people with musculoskeletal conditions.
Our work has indicated that while most men in the study did not do much physical activity, there was a wide range in activity levels. In addition, there were some differences in sleep patterns between men with and without pain. Those with high levels of exercise across the week day, also had high levels over the weekend. Some had lower levels during the week but had higher levels of weekend activity. Those with high pain levels also tended to have lower levels of activity. However, there were other participants with some level of pain who did undertake moderate/vigorous activity. There were also differences in time spent sleeping among those with and without pain. Other factors such as the location of pain, body mass index and depression also have a role to play.
More detailed analyses are being undertaken. These include the impact of medications and other co-morbidities. This information will be used to clarify the relationships further. Longitudinal analyses are also being undertaken to examine the associations over time with sleep, pain and activity.
The findings can be used in the future to provide an understanding of the relationships between sleep, pain and activity. Once this is understood, education and interventions can be designed to reduce musculoskeletal pain through improving sleep and activity levels and enhance the quality of life.
Once we have fully clarified the relationships, we will conduct intervention trials among people with musculoskeletal pain.