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Lengthening sleep reduces pain in childhood arthritis: a crossover randomised controlled trial
Hayyah Clairman1, Saunya Dover1, George Tomlinson2
1Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
Insights
Ensuring adequate sleep for adolescents with juvenile idiopathic arthritis (JIA) can significantly reduce their pain. This study confirms that longer, healthy sleep duration causally lowers pain in JIA patients.
Area of Science:
- Pediatric Rheumatology
- Sleep Medicine
- Pain Management
Background:
- Juvenile idiopathic arthritis (JIA) is a prevalent chronic childhood condition.
- Chronic pain is a major challenge for individuals with JIA.
- A strong correlation exists between poor sleep and increased pain in JIA, but causality is unclear.
Purpose of the Study:
- To investigate the causal relationship between sleep duration and pain in adolescents with JIA.
- To determine if a healthy sleep duration reduces pain compared to restricted sleep.
Main Methods:
- A randomized crossover study involving 31 adolescents (12-18 years) with JIA.
- Participants experienced a baseline week, a healthy sleep duration (HSD) week (9.5 hours), and a restricted sleep (RS) week (6.5 hours).
- Pain was self-assessed using the iCanCope with Pain app; Bayesian models analyzed the data.
Main Results:
- Adolescents slept an average of 1.4 hours more per night during HSD compared to RS.
- Healthy sleep duration (HSD) led to a significant reduction in pain scores compared to restricted sleep (RS) (OR 0.61).
Conclusions:
- Adolescents with JIA can achieve healthier sleep durations.
- Increased sleep duration in JIA patients causally reduces pain, supporting previous correlational findings.
Objectives:
Juvenile idiopathic arthritis (JIA) is a common chronic childhood disease and chronic pain is a debilitating feature. A strong link has been shown between poor sleep and pain in JIA. However, the causal direction is unknown. This study's aim was to determine if, in adolescents with JIA, a recommended healthful sleep duration leads to reductions in pain when compared with the restricted sleep (RS) duration that is commonly seen.
Methods:
Patients with JIA (12-18 years old; pain score of ≥1 on a visual analogue scale) participated in a randomised, crossover sleep manipulation protocol. The 3-week protocol comprised a baseline week (BL), a week with healthy sleep duration (HSD; 9.5 hours in bed/night) and a RS week (RS; 6.5 hours in bed/night). After BL, participants were randomly assigned to either HSD or RS, and then crossed over to the other condition. Pain was self-assessed using the iCanCope with Pain app. We used Bayesian hierarchical models to estimate the effect of sleep duration on pain.
Results:
Participants (n=31; mean age=15.0±1.8 years) averaged 1.4 (95% credible interval (CrI) 1.2-1.6) more hours of sleep per night during HSD relative to RS. Compared with RS, HSD resulted in a favourable effect on pain scores (OR 0.61, 95% CrI 0.39-0.95).
Conclusion:
It is possible to have adolescents with childhood arthritis get a healthier sleep duration, and this longer sleep results in reduced pain. These findings complement prior correlational studies and confirm a causal relationship between reduced sleep duration and increased pain.
Trial Registration Number:
NCT04133662.
