Back pain precedes sleep problems in older men

While cross-sectional associations between any pain and sleep problems have been established, longitudinal studies examining the temporal relationship between back pain and multidimensional sleep health remain limited. We evaluated whether the association between back pain and sleep problems was bidirectional in older men aged 65 years and above.

Data came from the Osteoporotic Fractures in Men Study with a sample of 1,055 older men who completed 2 clinical sleep visits. A composite sleep problems score was created using self-report and actigraphy data reflecting irregularity, dissatisfaction, lack of daytime alertness, suboptimal timing, inefficiency, and suboptimal duration. Participants were queried by mail about back pain every 4 months, and we calculated the prevalence of any, frequent, severe, and activity-limiting back pain around their 2 sleep visits. Cross-lagged panel models estimated bidirectional associations between sleep problems and subsequent back pain, and vice versa, over 6 years.

Multivariable-adjusted results showed that having any back pain, frequent back pain, severe back pain, and activity-limiting back pain predicted 12%-25% greater sleep problems 6 years later (Exp(β) = 1.12; 95% confidence interval [CI] = 1.03-1.21 to Exp(β) = 1.25; 95% CI = 1.05-1.48), but sleep problems did not predict subsequent back pain.

This study highlights the long-term temporal directionality of the association between back pain and sleep problems in older men. Back pain preceded more sleep problems, but an inverse association was not observed. Our findings suggest that interventions targeting back pain may help decrease sleep problems in older men and warrant further investigation into potential mechanisms.