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Assessing racial/ethnic differences in sleep-pain relationships using intensive longitudinal modeling among Native
Jamie L Rhudy1,2, Parker A Kell1,3, Joanna O Shadlow4
1TSET Health Promotion Research Center, University of Oklahoma Health Sciences, Tulsa, OK, United States.
Sleep
|July 25, 2025
Summary
Poor sleep quality is linked to increased pain, particularly in Native Americans (NAs). While sleep impacts pain more than the reverse, it may not fully explain the NA pain disparity.
Area of Science:
- Sleep science
- Pain research
- Health disparities
Background:
- Native Americans (NAs) exhibit higher chronic pain rates.
- Sleep problems are prevalent among NAs, potentially contributing to pain disparities.
- Bidirectional relationship exists between sleep and pain, with sleep having a stronger influence.
Purpose of the Study:
- To investigate longitudinal, temporal relationships between sleep and pain across racial/ethnic groups.
- To assess if sleep-pain temporal dynamics differ in Native Americans compared to other groups.
- To examine the role of sleep in the Native American pain disparity.
Main Methods:
- Secondary analysis of a mobile health intervention clinical trial.
- Ecological Momentary Assessments (EMAs) of sleep quality, duration, and pain intensity over 6 months.
- Dynamic structural equation modeling to analyze cross-lagged, temporal relationships, controlling for confounds.
Main Results:
- Confirmed reciprocal sleep-pain relationship: poor sleep quality increased next-morning pain, and higher pain decreased next-day sleep quality.
- The influence of sleep on pain was stronger than the influence of pain on sleep.
- A stronger association between sleep quality and pain was observed in Native Americans compared to Black participants.
Conclusions:
- Sleep-pain relationships are present in Native Americans and other minoritized groups.
- Poor sleep quality is a significant factor associated with pain in these populations.
- Poor sleep alone does not fully account for the observed Native American pain disparities.
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