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Prospective Mediation Models of Sleep, Pain, and Daily Function in Children With Arthritis Using Ecological Momentary

Maggie H Bromberg1, Mark Connelly, Kelly K Anthony

  • 1*Psychology Department, University of North Carolina at Chapel Hill, Chapel Hill §Department of Pediatrics, Duke University Medical Center, Durham, NC †Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA ‡Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.

The Clinical Journal of Pain
|September 5, 2015
PubMed

Insights

Poor sleep quality and difficulty initiating sleep in children with juvenile idiopathic arthritis (JIA) are linked to functional limitations, with pain intensity acting as a partial mediator. These findings highlight sleep

Area of Science:

  • Pediatric Rheumatology
  • Sleep Medicine
  • Pain Management

Background:

  • Juvenile idiopathic arthritis (JIA) significantly impacts children's quality of life.
  • Poor sleep quality is increasingly recognized in pediatric pain populations, including JIA.
  • Limited research exists on the prospective associations between sleep and outcomes in JIA.

Purpose of the Study:

  • To investigate the prospective associations between subjective sleep characteristics (quality, initiation, duration), pain intensity, and functional limitations in children with JIA.
  • To determine if pain intensity mediates the relationship between sleep and functional limitations.
  • To evaluate the direction and magnitude of these associations.

Main Methods:

  • A prospective study involving 59 children and adolescents with JIA (aged 8-18 years).
  • Participants completed smartphone-based diaries for one month.
  • Sleep characteristics were recorded daily; pain and functioning were assessed thrice daily.

Main Results:

  • Pain intensity partially mediated the association between sleep quality and functional limitations (z=-3.27, P=0.001).
  • Pain intensity also partially mediated the link between difficulty initiating sleep and functional limitations (z=2.70, P<0.05).
  • No significant mediation was found for sleep duration, pain intensity, and functional limitations (z=-0.58, P=0.56).

Conclusions:

  • Sleep quality and initiation difficulties are closely linked to functional limitations in JIA, mediated by pain intensity.
  • Sleep plays a crucial role in the interplay between pain and function in children with JIA.
  • Targeting sleep disturbances may be beneficial for improving function in pediatric arthritis patients.
Abstract

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