Sleep Impairment and Chronic Pain in the Military: A Scoping Review

This scoping review explores the bidirectional association between chronic pain and sleep disorders in military personnel. It aims to identify gaps in existing studies, offering tools for diagnosing and treating sleep disorders, chronic pain, and their comorbidities. Observational and interventional studies up to 2024 that approached the relationship between chronic pain and sleep disorders were included. Furthermore, PTSD, anxiety, depression, alcohol consumption, suicidal ideation and drug abuse were considered covariables. Cancer-related or acute pain and studies primarily addressing sleep apnoea or traumatic brain injury were excluded. A systematic search was conducted in ScienceDirect, PubMed, Scopus, Embase, Web of Science and Google Scholar until April 2024. Articles were screened using Covidence by two independent researchers, and bias was assessed using the Newcastle Ottawa Scale, ROBINS-I and ROB-2. Sixteen articles analysed data from 15,060 active military personnel or veterans. Overall, studies endorsed the association between sleep quality and chronic pain and their influence on mental health, physical functioning and quality of life. Additionally, behavioural, mind-body and circadian misalignment therapies, along with other nonpharmacologic interventions, positively impacted outcomes related to pain, sleep quality, and psychiatric comorbidities. However, there was heterogeneity in the use of diagnostic tools, non-standardised procedures, and a lack of guidelines in the treatment of these conditions. The construct of sleep disorders, chronic pain and associated comorbidities was shown to improve with nonpharmacologic and integrative interventions that addressed at least one of these conditions.