The Relationship Between Disordered Sleep and Pain Perception in Patients with Peripheral Neuropathy
Julia Greenberg1, Sophia Tong1, Christina Marini1, Azizi Seixas3, Kiril Kiprovski1, Lisa Doan2, Ricardo Osorio1, Sujata Thawani1
1Neurology, 2Pain Management, NYU Langone Health, 3Neurology, University of Miami Miller School of Medicine
Objective:
To assess the relationship between disordered sleep and pain perception in patients with peripheral neuropathy.
Background:
The crucial role of sleep in the modulation of pain is well established, and there is evidence to suggest that the treatment of disordered sleep in patients with neuropathic pain improves pain perception. However, studies on this topic remain limited in painful peripheral neuropathy.
Design/Methods:
The associations between disordered sleep, pain perception, and neuropathic symptoms were examined cross-sectionally in 24 subjects with peripheral neuropathy diagnosed by a neurologist. For each subject validated scales assessing sleep quality (Neuro-QoL Sleep, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI)), pain perception (Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS)), and neuropathic symptoms (Michigan Neuropathy Screening Instrument (MNSI) were compared. All models were adjusted for age, sex, body mass index, history of sleep disorder, and mood disorder (depression/anxiety).
Results:
75% of participants enrolled were female (18/24) with a mean age of 66.9 years (SD ∓ 10.5). Worse pain severity measured by BPI was associated with higher ISI (p=0.020), PSQI (p=0.047), and Neuro QoL Sleep (p=0.01), but not ESS (p=0.241) or FOSQ-10 (p=0.824). Similarly, higher PCS was associated with higher ISI (p=0.003), PSQI (p=0.09) and Neuro-QoL Sleep (p=0.001), but not ESS (p=0.155) or FOSQ-10 (p=0.410). MNSI score ≥7 was associated with worse sleep outcomes on all scales - ISI (p=0.009), PSQI (p=.048), Neuro-QoL Sleep (p=0.01), FOSQ-10 (p=0.005), ESS (p=0.01), FOSQ-10 (p=0.005).
Conclusions:
We demonstrate associations between several measures of disordered sleep and elevated pain perception and neuropathic symptoms in patients with peripheral neuropathy. Importantly, disordered sleep is modifiable with targeted pharmacologic and nonpharmacologic interventions - establishing and characterizing this relationship therefore has important implications for the use of current therapies and the development of new therapies targeting sleep and neuropathic pain.