Abstract
This study aimed to investigate the association between poor sleep and risk of low-back pain (LBP) in healthcare workers. Using a prospective cohort design with 1-year follow-up, a total of 1955 healthcare workers (60% nurses) from 389 departments at 19 hospitals responded to questionnaires containing items related to lifestyle, health, and working environment. Associations between sleep scores (0–100) at baseline and LBP intensity (0–10) at follow-up were modelled using cumulative logistic regression accounting for clustering at the department level and adjusted for lifestyle and psychosocial confounders. In the full population of healthcare workers, 43.9% and 24.4% experienced moderate and poor sleep, respectively. In the fully adjusted model with good sleep as reference, moderate, and poor sleep increased the risk of LBP at follow-up, with odds ratios (OR’s) of 1.66 (95% confidence interval (CI) 1.35–2.04) and 2.05 (95% CI 1.57–2.69), respectively. Three sensitivity analyses including healthcare workers free from LBP, nurses, and nurses free from LBP at baseline, respectively, yielded similar results. In conclusion, poor sleep constitutes a potent risk factor for LBP among healthcare workers. The presented results provide strong incentives to evaluate and weigh current prevention policies against an updated biopsychosocial framework.
Highlights
Sleep constitutes an complex and vital biological function, with the behaviorally-driven goal to maintain homeostasis across multiple physiological systems: It is essential for recuperation of physical and psychological stressors, learning, physical performance, cognition, emotional modulation, brain plasticity memory encoding, and consolidation, as well as overall health of the mammalian organism [1,2,3,4]
With “good sleep” as reference, this prospective study presents fully-adjusted associations between baseline sleep scores and risk of low-back pain (LBP) at follow-up in the full population of healthcare workers
In the sensitivity analysis including healthcare workers without LBP at baseline, similar associations were observed
Summary
Sleep constitutes an complex and vital biological function, with the behaviorally-driven goal to maintain homeostasis across multiple physiological systems: It is essential for recuperation of physical and psychological stressors, learning, physical performance, cognition, emotional modulation, brain plasticity memory encoding, and consolidation, as well as overall health of the mammalian organism [1,2,3,4]. Interventional and epidemiological studies alike, considerable effort has been devoted to progressively shed light on the relationship between sleep and pain [8,11,12,13,14,15,16,17]. A recent meta-analysis with pooled estimates from 37 studies using polysomonography in populations with persistent pain, reported a 72% prevalence of insomnia [18]. This interrelation between sleep and pain is echoed in recent reviews [8,13,19], which, in contrast to previous studies investigating (bi)directionality, highlights a more consistent unidirectional effect of poor sleep on pain exacerbation and vulnerability. Populations exposed to work-related and environmental stressors (e.g., odd working hours, job dissatisfaction, psychosocial stress etc.) are, likely to be more vulnerable to pain due to the stressors themselves [20], but, perhaps
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