Assessing racial/ethnic differences in sleep–pain relationships using intensive longitudinal modeling among Native Americans

This is the authors' abstract. We don't add key points for this paper.

STUDY OBJECTIVES: Native Americans (NAs) experience higher rates of chronic pain than other U.S. racial/ethnic groups. Sleep and pain share a bidirectional relationship, but sleep impacts pain more than the reverse. NAs experience high rates of sleep problems; thus, sleep may contribute to the NA pain disparity. To date, there have been no intensive longitudinal assessments of sleep and pain to assess whether sleep-pain temporal relationships differ across racial/ethnic groups, including NAs. METHODS: To address this research gap, a secondary analysis of a clinical trial of a mobile health intervention for anxiety and/or depression sample was conducted. NA (n = 199), White (n = 205), Black (n = 198), and Hispanic adults (n = 199) completed ecological momentary assessments of daily sleep quality, sleep duration, and morning and evening pain intensity for 6-months. Dynamic structural equation modeling was used to assess cross-lagged, temporal relationships between sleep and pain, while controlling potential confounds. RESULTS: As expected, there was a reciprocal sleep-pain relationship; lower sleep quality was associated with higher next-morning pain and higher pain was associated with lower next-day sleep quality. The sleep to pain path was stronger than the reverse. Evening pain was also associated with next-night sleep quality. Sleep duration was not temporally related to pain. There was a stronger sleep quality-pain association in NAs compared to Black participants, but no other racial/ethnic difference was significant. CONCLUSIONS: This is the first study to show that sleep-pain relationships extend to NAs and other minoritized groups, but poor sleep may not fully account for NA pain disparities. CLINICAL TRIAL: Mobile Health and COVID-19, https://clinicaltrials.gov/study/NCT05074693, NCT05074693 Statement of Significance This is the first study to examine sleep-pain relationships in Native Americans (NAs), a group that experiences significant pain disparities. Sleep quality was related to morning pain and morning pain was related to sleep quality, but the effect of sleep quality on pain was stronger than the reverse. Similar relationships were found in other racial/ethnic groups (Black, Hispanic, White), except that the sleep-pain path was stronger in NAs than Black participants. Together, these findings suggest that poor sleep contributes to pain and that pain contributes to poor sleep in all groups and does not fully account for the NA pain disparity.