The Relationship Between Sleep Quality, Pain, and Health-Related Quality of Life in Entry-Level Marines

Sleep health is associated with health-related quality of life (HRQOL) in the general population and may be a modifiable factor in entry-level Marines engaged in training. Entry-level Marines commonly experience pain during training and is a factor that affects both sleep and HRQOL. Since poor sleep health is deleterious to warfighter performance and operational readiness, identifying these relationships may help to inform the policies and practices needed to improve, prevent, and treat disordered sleep and pain. Therefore, the purpose of this research was to determine the relationship between sleep health, pain, and HRQOL in entry-level Marines and the moderating effects of pain on the relationship.

A cross-sectional analysis of data collected in a larger longitudinal study was performed. All participants completed a demographics and medical history form, the Pittsburgh Sleep Quality Index Questionnaire, the Defense and Veterans Pain Rating Scale, and the PROMIS Physical and Mental Health Short Form at enrollment. Separate multivariate regression models, one for each outcome (physical HRQOL and mental HRQOL), were performed. Each regression model included age and months of service as covariates. Partial eta-squared effect size estimates were calculated for each predictor.

A total of 785 entry-level Marines (73.4% male; mean age: 19.96 ± 2.39; mean months in service: 4.88 ± 3.13) were included in this analysis. The participants endorsed some degree of sleep difficulty (mean ± SD: 4.81 ± 2.85) and pain (mean ± SD: 0.82 ± 1.22). Greater sleep difficulty was associated with worse physical (B = -1.76, P < .001, ηp2 = .06) and mental HRQOL (B = -2.85, P < .001, ηp2 = .10). Although pain intensity did not moderate either relationship, pain interference emerged as a moderating variable between sleep health and HRQOL. Entry-level Marines who had greater pain interference and sleep difficulty had worse physical (B = -0.50, P = .03, ηp2 = .01) and mental HRQOL (B = -0.65, P = .03, ηp2 = .01).

These results suggest that early education related to sleep health and pain interference are mechanisms to enhance both physical and mental HRQOL in entry-level Marines.