Associations Between Widespread Pain and Sleep Quality in People With HIV

BACKGROUND:We investigate the association of widespread pain with sleep quality among people with HIV and HIV-negative controls. SETTING:UK-based cohort. METHODS:Pain information was collected through a pain mannikin identifying affected body sites; pain was classified as widespread if pain was reported in ≥4 of 5 body regions and in ≥7 of 15 body sites, and as regional otherwise. Sleep was assessed a median of 3.2 years later through 7-night actigraphy and through self-reported assessments of sleep quality. Chi-squared tests, Kruskal–Wallis tests, and linear/logistic regression considered associations between pain extent and sleep quality. RESULTS:Of the 414 participants, 74 (17.9%) reported widespread and 189 (45.7%) regional pain. Although there were few clear associations between actigraphy outcomes and pain extent, those with widespread and regional pain consistently reported poorer sleep quality on all self-reported measures than those with no pain. Median (interquartile range) insomnia severity index and Patient-reported Outcomes Measurement Information System (PROMIS) for sleep disturbance and sleep-related impairment scores were 12 (7–16), 55.3 (48.0–58.9), and 57.2 (48.9–61.3), respectively, for those with widespread pain, 8 (4–13), 51.2 (45.5–58.3), and 50.3 (43.6–56.1) for those with regional pain, and 5 (2–9), 47.9 (42.9–54.3), and 45.5 (41.4–50.3) for those with no pain (all P values 0.0001). Associations remained strong after adjustment for HIV status and other confounders, and were reduced but remained significant, after adjustment for depressive symptoms. CONCLUSIONS:Widespread pain was not associated with objective measures of sleep but was strongly associated with self-reported assessments of sleep quality in people with HIV.