Longitudinal Associations Between Sleep and Pain Experiences Among Twins in Middle Childhood

• In Event: 2-199 - Cross-sectional and Longitudinal Factors Linked to Pain Experiences Across Child Development

Integrative Statement

Objective: Disrupted and low quality sleep and pain have been associated among children, and both are related to poor health outcomes (Allen et al., 2016). Sleep deficiency has been predictive of a greater odds of having later pain among children in late childhood and early adolescence (Inceldon et al., 2016). Such associations may be amplified or diminished for particular children who may experience contextual or individual protective or vulnerability factors. This study uses a prospective design to examine the association between child sleep at 8 years of age and both recurrent and acute pain at 9 years of age among twins in middle childhood. We examined children’s internalizing symptoms and family socioeconomic status [SES] as moderators of associations between sleep and pain.

Methods: Families are part of an ongoing longitudinal study of twins recruited from birth records. At 8 years of age, 258 twins (49.2% female, 54.8% non-Hispanic White, 32.3% Hispanic) and primary caregivers participated in an intensive assessment focused on child sleep. Twins wore an actigraph watch on their non-dominant wrist for 7 consecutive nights, and caregivers reported on child internalizing symptoms and SES. One year later, families participated in another assessment focused on child pain. Twins and caregivers both reported on child pain and twins completed a cold water task in which they immersed their hand into ice cold water and kept it submerged for as long as they could (up to 4 minutes).

Results: Approximately 69.9% of children reported pain in at least one bodily location once a month or more, with 40.2% reporting multisite pain (≥3 sites). Caregiver reports indicated that 53.6% of children had monthly or more pain and 25.8% had multisite pain. Based on correlations, sleep efficiency was chosen as the parameter to examine in association with child pain. Child internalizing symptoms moderated the association between sleep efficiency and child reports of pain (b=-0.38, p=.04), such that lower efficiency was associated with greater pain for children who had higher internalizing symptoms (Figure 1). The same association was seen with caregiver reports of child pain at the trend level (b=-0.23, p=.06). Further, child internalizing symptoms moderated the association between sleep efficiency and multisite pain in the same direction (b=-0.37, p=.046). SES moderated the association between sleep efficiency and cold pressor task time (b=0.02, p=.01). For children from lower SES households, lower efficiency was associated with longer cold pressor times (Figure 2).

Conclusions: Findings suggest that internalizing symptoms may exacerbate the association between poor sleep quality and greater pain among children. For children from lower SES households, poor sleep was associated with the ability to withstand acute pain tasks for longer durations, which may be an indication of higher pain tolerance due to experiences with pain. Interventions focused on improving child pain outcomes may need to target poor sleep as a precursor for certain populations. Future work is needed to examine the genetic and environmental contributions to the association of child sleep and pain.

Authors

• Samantha A Miadich, Arizona State University
  Presenting Author

• Reagan Styles Breitenstein, Arizona State University
  Non-Presenting Author

• Mary C. Davis, Arizona State University
  Non-Presenting Author

• Leah D. Doane, Arizona State University
  Non-Presenting Author

• Kathryn Lemery-Chalfant, Arizona State University
  Non-Presenting Author