Sleep quality among people living with chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) cohort

Study Objectives: To examine sleep disturbances in the POINT cohort study consisting of participants prescribed long-term opioids for chronic non-cancer pain (CNCP), and to examine the relationship between sleep and measures of pain, physical and mental health, substance use and medication use at the baseline interview.

Methods: A convenience sample of 1243 participants with current CNCP and prescription opioid use were recruited from community settings and underwent a structured interview examining subjective sleep symptoms (Medical Outcomes Study (MOS) Sleep Scale and the Sleep Problems Index (SLP-9)), pain severity and interference using the Brief Pain Inventory, mental and physical health symptoms, recent substance and medication use. Linear regression models assessed independent predictors of SLP-9 scores.

Results: Median hours of sleep per night was 6 (IQR 5-7.5) with 26% reporting optimal sleep (seven to eight hours), and a mean SLP-9 score of 47.3 (SD = 20.9). On multivariate analysis, age, frequent/severe headaches, total BPI pain severity and pain interference scores, moderate to severe anxiety or depression, daily tobacco use and past week benzodiazepine use were significant predictors of SLP-9 scores and sleep quality. Higher MOS respiratory impairment was observed in males, those with high BMI, frequent/severe headaches, high pain interference scores and in patients taking anticonvulsants and antipsychotic medications. Opioid use was not associated with SLP-9 or respiratory sleep impairment.

Conclusions: High levels of sleep problems were reported in this community sample of CNCP patients, and were associated with mental health problems and increased medication use. Non-medication approaches to addressing sleep problems should be prioritised in this population.