Sleep disturbance is associated with neck pain: a 3-year longitudinal study after the Great East Japan Earthquake

doi:10.21203/rs.3.rs-1441841/v1

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Sleep disturbance is associated with neck pain: a 3-year longitudinal study after the Great East Japan Earthquake

https://doi.org/10.21203/rs.3.rs-1441841/v1

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Background: Neck pain is a common health problem in the general population as well as in people after natural disasters. Sleep disturbances are gaining attention as risk factors for musculoskeletal pain; however, the association between sleep disturbance and neck pain has not been clarified. The present study aimed to clarify the association between sleep disturbance and neck pain, especially focusing on the effect of the duration of sleep disturbance.

Methods: This study used 3-year longitudinal data obtained from individuals (n = 2,059) living in disaster-affected areas after the Great East Japan Earthquake. Sleep disturbance and neck pain were investigated at 4, 5, 6, and 7 years after the disaster. Multiple logistic regression analyses were used for the assessment.

Results: Sleep disturbance was significantly associated with neck pain, and the association was stronger as the duration of sleep disturbance increased (adjusted odds ratios [95% confidence intervals]: 1.84 [1.23-2.75] for “<1 year”; 2.41 [1.53-3.81] for “≥1 year and <2 years”; 2.80 [2.09-3.76] for “≥2 years”). Furthermore, preceding sleep disturbance was significantly associated with the onset of neck pain, and the association was stronger as the duration of sleep disturbance increased (adjusted odds ratios [95% confidence intervals]: 1.86 [1.08-3.20] for “< 1 year”; 2.39 [1.22-4.70] for “≥ 1 year and < 2 years”; 3.00 [1.94-4.65] for “≥ 2 years”).

Conclusions: Sleep disturbance is associated with neck pain, and long-lasting sleep disturbance strengthens the association. Clinicians should consider this association to effectively treat patients with neck pain.

neck pain

sleep disturbance

natural disaster

the Great East Japan Earthquake

survey

physical condition

mental health

psychological distress

social network

economic status.

Neck pain is a common health problem worldwide [1]. Generally, other terms are also used in similar symptoms with neck pain, such as neck/shoulder pain in European countries and katakori in Japan [2, 3]. Neck pain is often a cause of disability and identifying the risk factors is important for the treatment of neck pain [4]. Some factors such as age, sex, working status, and psychosocial conditions are reported to be related to neck pain [1, 5–7]. In recent years, sleep disturbances are gaining interest as risk factors for musculoskeletal pain [8, 9], and some authors have reported the association between sleep disturbance and neck pain [10–15]. Some cross-sectional studies have shown a high rate of sleep disturbance among people with neck pain [10, 14]. Moreover, some authors have shown that sleep disturbance is a prognostic factor of neck pain in longitudinal studies [12, 13]. Although there have been some reports on this topic, its number is small and the association of sleep disturbance with neck pain is not clarified.

Musculoskeletal pain and sleep disturbance are common problems after natural disasters [16]. The Great East Japan Earthquake (GEJE) attacked the northeast coastal areas of Japan on 11 March 2011, which caused severe damage to these areas [17]. Although reports of neck pain after natural disasters are rare, the prevalence of neck pain was reported to be high after the GEJE, and deteriorated subjective economic conditions were associated with neck pain onset [18]. Furthermore, stressful conditions after the disaster increase sleep disturbance [19], which may also be associated with neck pain; however, the association between sleep disturbance and neck pain after natural disasters has not been reported. Clarifying the association between sleep disturbance and neck pain is important to develop strategies for the treatment of neck pain among people after natural disasters, which is also useful for the general population. The purpose of the present study was to elucidate the association between sleep disturbance and neck pain using 3-year cohort data of people after the GEJE, especially focusing on the effect of duration of sleep disturbance.

Participants

A longitudinal study has been conducted with people living in disaster-affected areas after the GEJE, such as Ogatsu, Oshika, and Ajishima areas in Ishinomaki city and Wakabayashi Ward in Sendai city in Japan, which is still going on. This cohort aims to assess and support the physical and mental health conditions of people living in these areas since the health system was destroyed by the disaster. The first survey was conducted 3 months after the GEJE and repeated annually. The initial population included in the survey were residents registered in the basic residential registry of Ogatsu, Oshika, and Ajishima areas and people living in prefabricated housing in Wakabayashi Ward. The present study used the data at 4, 5, 6, and 7 years after the GEJE (defined as the first, second, third, and fourth points, respectively). For each time-point survey, the people who had participated in the survey conducted the previous year were called up (age ≥ 18 years). At the first point, 4,324 people were recruited, and 3,032 responded (70.1%). Among these 3,032 individuals, 2,635 participated in the second-point survey (86.9%). Of the 2,635 people, 2,361 responded to the third-point survey (89.6%). Among these 2,361 individuals, 2,119 participated in the fourth-point survey (89.8%). People with missing data on sleep conditions were excluded (n = 60), and 2,059 were finally included in this study (Fig. 1).

Neck pain

Neck pain was assessed using a self-reported questionnaire. The participants were asked if they had katakori (neck pain) in the last few days. We used the data of neck pain at the fourth point to assess the association between sleep disturbance and neck pain. In addition, we used the data of neck pain at the third and fourth points to assess the effect of preceding sleep disturbance on the onset of neck pain.

Sleep disturbance

Sleep disturbance was assessed using the Athens Insomnia Scale (AIS) and defined as a score of > 6/24 on the AIS [20]. Duration of sleep disturbance at the fourth point was defined and categorised into four groups as follows: (i) absent, absence of sleep disturbance at the fourth point; (ii) < 1 year, absence of sleep disturbance at the third point and presence of sleep disturbance at the fourth point; (iii) ≥ 1 year and < 2 years, absence of sleep disturbance at the second point and presence of sleep disturbance at the third and fourth points; and (iv) ≥ 2 years, presence of sleep disturbance at the second, third, and fourth points.

The duration of sleep disturbance at the third point was also defined and categorised into four groups as follows: (1) absent, absence of sleep disturbance at the third point; (2) < 1 year, absence of sleep disturbance at the second point and presence of sleep disturbance at the third point; (3) ≥ 1 year and < 2 years, absence of sleep disturbance at the first point and presence of sleep disturbance at the second and third points; (4) and ≥ 2 years, presence of sleep disturbance at the first, second, and third points.

Covariates

The following variables at the third or fourth point were included in the analysis as covariates because they had the potential to be confounding factors: sex, age, body mass index, living area and status, smoking and drinking habits, comorbid conditions, working conditions, walking time per day, economic and psychological conditions, and social network. Psychological condition was assessed using the Kessler Psychological Distress Scale, and a score of > 10/24 was defined as having psychological distress [21]. Social network was assessed using the Lubben Social Network Scale, and a score of < 12/30 was defined as experiencing social isolation [22]. These variables were categorised as shown in Table 1.

Statistical analysis

The χ² test was used to compare covariates due to sleep disturbances. Crude and multiple logistic regression analyses were performed to assess the association between sleep disturbance and neck pain; the results were presented with their respective odds ratios (ORs) and 95% confidence intervals (CIs). In all analyses, the outcome of interest was neck pain at the fourth point. First, sleep disturbance at the fourth point was used as the main predictor to assess the association between sleep disturbance and neck pain. Furthermore, the association between the duration of sleep disturbance at the fourth point and neck pain was assessed. In addition, the participants were divided into subgroups based on age (< 65 years or ≥ 65 years) and sex (male or female), and the association between sleep disturbance and neck pain was also assessed in these subgroups. The Wald test was used to assess the multiplicative interaction between sleep disturbance and age or sex. The covariates were set as variables at the fourth point in these analyses. Second, participants without neck pain at the third point were selected, and sleep disturbance at the third point was used as the main predictor to assess the effect of preceding sleep disturbance on the onset of neck pain. Furthermore, the effect of the duration of sleep disturbance at the third point on the onset of neck pain was also assessed. The covariates were set as variables at the third point in these analyses. SPSS (version 24.0: IBM Corp., Armonk. NY) was used for all statistical analyses, and a p value of < 0.05, was considered significant.

The variables divided by sleep disturbances are shown in Table 1. At the fourth point, 33.4% of the participants had sleep disturbances. The variables associated with sleep disturbance were sex, age, living area, walking time per day, living status, economic condition, psychological distress, and social isolation. The rate of neck pain at the fourth point was 19.9% (410/2,059). Sleep disturbance was significantly associated with neck pain and adjusted OR (95% CI) in presence of sleep disturbance was 2.45 (1.91–3.15) when the absence of sleep disturbance was the reference. Furthermore, with a longer duration, sleep disturbance was associated with increased neck pain. Using the absence of sleep disturbance as the reference, adjusted ORs (95% CIs) were 1.84 (1.23–2.75) in “<1 year”, 2.41 (1.53–3.81) in “≥1 year and < 2 years”, and 2.80 (2.09–3.76) in “≥2 years” (p for trend < 0.001) (Table 2). In the stratified analyses, sleep disturbance was also significantly associated with neck pain in each subgroup, and the association was stronger as the duration of sleep disturbance increased. There was no significant multiplicative interaction between sleep disturbance and age or sex (Table 3).

In participants without neck pain at the third point, the rate of onset of neck pain at the fourth point was 10.6% (174/1,647). Sleep disturbance at the third point was significantly associated with the onset of neck pain at the fourth point and adjusted OR (95% CI) in presence of sleep disturbance was 2.47 (1.72–3.55) when the absence of sleep disturbance was the reference. Moreover, with a longer duration, sleep disturbance at the third point was associated with the onset of increased neck pain. Using the absence of sleep disturbance as the reference, adjusted ORs (95% CIs) were 1.86 (1.08–3.20) in “<1 year”, 2.39 (1.22–4.70) in “≥1 year and < 2 years”, and 3.00 (1.94–4.65) in “≥2 years” (p for trend < 0.001) (Table 4).

The present study revealed that sleep disturbance was significantly associated with neck pain, which was stronger with a longer duration of sleep disturbance. Furthermore, preceding sleep disturbance was significantly associated with the onset of neck pain, and the association was stronger as the duration of sleep disturbance increased.

Nowadays, an increasing number of reports have shown an association between sleep disturbance and pain, which is observed in several types of pain, such as fibromyalgia, rheumatoid arthritis, orofacial pain, and low back pain [8, 9, 23, 24]. Regarding neck pain, although the number of reports is few, some authors have also shown an association with sleep disturbance. Artner et al. reported that approximately 41% of people with neck pain presented with sleep disturbance [10]. Kovacs et al. showed that improvement of neck pain was poorer in patients with sleep disturbance than in those without sleep disturbance [12]. The present study also reported that people with sleep disturbance had a significantly higher rate of neck pain than those without sleep disturbance, which supported the significant association between sleep disturbance and neck pain. In addition, Valenza et al. showed that the intensity of neck pain was higher with worse sleep quality, which implies that the association between sleep disturbance and neck pain was dose-dependent. We hypothesised that the duration of sleep disturbance was associated with neck pain, which has not been reported to date. The results of this study clearly showed that the rate of neck pain was higher with a longer duration of sleep disturbance. Although the effect of the duration of sleep disturbance on pain has been rarely investigated, some studies have shown that the association is stronger with the increased duration or frequency of sleep disturbance among people with fibromyalgia or low back pain [25–27]. Sleep disturbance is associated with neck pain, and long-lasting sleep disturbance is considered to strengthen the association. Regarding the stratified analyses, the association between sleep disturbance and neck pain was significant, and the association was even stronger as the duration of sleep disturbance was longer in each group, which indicated the robustness of the results in this study.

Regarding the association between sleep disturbance and pain, their bidirectional effect has been reported [23]. A previous study reported that preceding musculoskeletal pain including neck pain was associated with the onset of sleep disturbance [16]. Conversely, some longitudinal studies have reported that preceding sleep disturbance is associated with the onset of musculoskeletal pain [25, 28], which has also been reported after natural disasters [29–31]. Regarding neck pain, a few reports have shown the effect of sleep disturbance on neck pain in longitudinal studies [13, 15]. Rasmussen et al. showed that sleep disturbance was associated with neck pain four years later among the working-age population, and the association was stronger along with worse sleep disturbance [13]. Mork et al. also reported that sleep disturbance was associated with neck pain 10 years later among the general population and the rate of neck pain was higher among people with more frequent sleep disturbance [15]. The present study assessed the people without neck pain at baseline, which could indicate that preceding sleep disturbance was significantly associated with the onset of neck pain 1 year later among people after a natural disaster. In addition, the association was stronger as the duration of sleep disturbance increased. Experimental human and animal studies indicated that sleep disturbance changed the descending pain inhibitory control system and prevented the analgesic action of endogenous opioids, which resulted in a reduction in the pain perception threshold [8, 23, 32]. This effect is considered to be stronger with worse or longer sleep disturbance. Sleep disturbance is considered to affect the onset of neck pain in a dose-dependent manner. Clinicians should consider this association to effectively treat patients with neck pain.

The present study had some limitations. First, we did not have data on people who did not participate in this study. Second, the intensity or duration of neck pain was not assessed. Sleep disturbance may worsen neck pain, which should be investigated in future studies. Finally, the participants of the present study were people living in disaster-stricken areas after the GEJE; thus, the generalisability of the results of this study may not be fully applicable.

In conclusion, sleep disturbance was associated with neck pain among people living in disaster-affected areas after the GEJE, and the association was stronger as the duration of sleep disturbance increased. Furthermore, preceding sleep disturbance was associated with the onset of neck pain, and the effect was stronger with longer durations of sleep disturbance.

GEJE

Great East Japan Earthquake

Odds ratio

95%CI

95% Confidence interval

Ethics approval and consent to participate:

The study protocol was reviewed and approved by the Ethics Committee of Tohoku University Graduate school of Medicine (approval number: 201192). Written informed consent was obtained from all the participants. All procedures were carried out in accordance with relevant guidelines and regulations.

Consent to publish

Not applicable

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare no conflict of interest.

Funding:

Not applicable

Authors’ contributions

YY, YH, and IT contributed to the design of the study. TS, YS, MT, and SY were responsible for data collection and supervised the study. YY and TS performed statistical analysis. YY and YH wrote the manuscript. YS, MT, YS, and IT helped to analyze the data and draft the manuscript.

Acknowledgements

This work was supported by Health Sciences Research Grants (H24, 25-Kenki-Shintei-002 [Fukkou]) from the Ministry of Health, Labor, and Welfare of Japan.

Authors’ information

¹Department of Orthopaedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. ²Division of Epidemiology, Department of Health informatics and Public Health, Tohoku University, Graduate School of Public Health, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan. ³Department of Nursing, Faculty of Health Science, Tohoku Fukushi University, 1-8-1, Kunimi, Aoba-ku, Sendai, Miyagi 981-8522, Japan.

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Table 1. Baseline characteristics.

		Sleep disturbance at the fourth time point
		n (%)	absence	presence	P value
		2,059	1,372	687
Sex	Male	911 (44.2)	662 (48.3)	249 (36.2)	< 0.001
	Female	1,148 (55.8)	710 (51.7)	438 (63.8)
Age	< 65	820 (39.8)	525 (38.3)	295 (42.9)	0.041
	≥ 65	1,239 (60.2)	847 (61.7)	392 (57.1)
Body mass index*	≥18.5, < 25	1,240 (60.2)	832 (60.6)	408 (59.4)	0.54
	< 18.5	38 (1.8)	22 (1.6)	16 (2.3)
	≥ 25	706 (34.3)	465 (33.9)	241 (35.1)
Living area	Ogatsu	857 (41.6)	534 (38.9)	323 (47.0)	< 0.001
	Oshika	740 (35.9)	526 (38.3)	214 (31.1)
	Ajishima	137 (6.7)	117 (8.5)	20 (2.9)
	Wakabayashi	325 (15.8)	195 (14.2)	130 (18.9)
Smoking habits*	Non-smoker	1,656 (80.4)	1,100 (80.2)	556 (80.9)	0.866
	Smoker	330 (16.0)	224 (16.3)	106 (15.4)
Drinking habits*	Non-drinker	1,292 (62.7)	839 (61.2)	453 (65.9)	0.05
	< 45.6g of alcohol/day**	438 (21.3)	315 (23.0)	123 (17.9)
	≥ 45.6g of alcohol/day**	161 (7.8)	110 (8.0)	51 (7.4)
Comorbid conditions	Hypertension	877 (42.6)	578 (42.1)	299 (43.5)	0.546
	Diabetes mellitus	222 (10.8)	151 (11.0)	71 (10.3)	0.643
	Myocardial infarction	135 (6.6)	85 (6.2)	50 (7.3)	0.349
	Cerebral stroke	31 (1.5)	18 (1.3)	13 (1.9)	0.308
Working status*	Unemployed	1,033 (50.2)	667 (48.6)	366 (53.3)	0.105
	Employed	973 (47.3)	671 (48.9)	302 (44.0)
Walking time/day*	≥ 1h	594 (28.8)	438 (31.9)	156 22.7)	< 0.001
	30min to < 1h	752 (36.5)	505 (36.8)	247 (36.0)
	< 30m	685 (33.3)	408 (29.7)	277 (40.3)
Living status*	Same house as before the GEJE	670 (32.5)	489 (35.6)	181 (26.3)	0.001
	Prefabricated house	83 (4.0)	48 (3.5)	35 (5.1)
	New house	654 (31.8)	419 (30.5)	235 (34.2)
	Others	629 (30.5)	400 (29.2)	229 (33.3)
Economic condition*	Normal	1,020 (49.5)	798 (58.2)	222 (32.3)	< 0.001
	A little hard	488 (23.7)	296 (21.6)	192 (27.9)
	Hard	324 (15.7)	174 (12.7)	150 (21.8)
	Very hard	191 (9.3)	77 (5.6)	114 (16.6)
Psychological distress*	Absence	1,775 (86.2)	1,289 (94.0)	486 (70.7)	< 0.001
	Presence	253 (12.3)	56 (4.1)	197 (28.7)
Social isolation*	Absence	1,454 (70.6)	1,025 (74.7)	429 (62.4)	< 0.001
	Presence	604 (29.3)	347 (25.3)	257 (37.4)
Because each item has a limited number of respondents, the actual number is not necessarily in accordance with the total. *22.8g of alcohol amount to 1 go or traditional unit of sake (180ml), which also approximates to two glasses of wine (200ml), or beer (500ml) in terms of alcohol content. Categorical values are presented as numbers and percentage (%). GEJE: Great East Japan Earthquake.

Table 2. Association between sleep disturbance and neck pain.

	Sleep disturbance at the fourth point
	Total	Absence	Presence			P value
Participants	2,059	1,372	687
Neck pain, n (%)	410 (19.9)	192 (14.0)	218 (31.7)
Crude OR (95% CI)		1 (Ref.)	2.86 (2.29-3.57)			< 0.001
Adjusted OR (95% CI)		1 (Ref.)	2.45 (1.91-3.15)			< 0.001
			duration
			< 1 year	³ 1 year, < 2 years	³ 2 years	P for trend
Participants			168	109	410
Neck pain, n (%)			43 (25.6)	34 (31.2)	141 (34.4)
Crude OR (95% CI)		1 (Ref.)	2.11 (1.45-3.09)	2.79 (1.81-4.30)	3.22 (2.50-4.16)	< 0.001
Adjusted OR (95%CI)		1 (Ref.)	1.84 (1.23-2.75)	2.41 (1.53-3.81)	2.80 (2.09-3.76)	< 0.001
Adjusted for sex, age, body mass index, living area, smoking habits, drinking habits, comorbid conditions, working status, walking time, living status, subjective economic condition, psychological distress, and social isolation. OR: Odds ratio, CI: Confidence interval

Table 3. Stratified analysis for age and sex.

	Duration of sleep disturbance
	Total	Absence	< 1 year	1 year, < 2 years	2 years	P for trend
Age (< 65 years old)
Participants	820	525	80	59	156
Neck pain, n (%)	205 (25.0)	89 (17.0)	25 (31.3)	24 (40.7)	67 (42.9)
Adjusted OR (95%CI)		1 (Ref.)	2.14 (1.21-3.80)	2.95 (1.58-5.50)	3.16 (2.00-4.99)	< 0.001
Age (³ 65 years old)
Participants	1,239	847	88	50	254
Neck pain, n (%)	205 (16.5)	103 (12.2)	18 (20.5)	10 (20.0)	74 (29.1)
Adjusted OR (95%CI)		1 (Ref.)	1.70 (0.94-3.07)	1.65 (0.77-3.54)	2.64 (1.77-3.93)	< 0.001
					P-interaction = 0.256
Sex (male)
Participants	911	662	67	39	143
Neck pain, n (%)	130 (14.3)	64 (9.7)	14 (20.9)	10 (25.6)	42 (29.4)
Adjusted OR (95%CI)		1 (Ref.)	2.18 (1.11-4.30)	3.01 (1.33-6.78)	3.51 (2.08-5.93)	< 0.001
Sex (female)
Participants	1,148	710	101	70	267
Neck pain, n (%)	280 (24.4)	128 (18.0)	29 (28.7)	24 (34.3)	99 (37.1)
Adjusted OR (95%CI)		1 (Ref.)	1.63 (0.98-2.71)	2.23 (1.26-3.95)	2.59 (1.80-3.72)	< 0.001
					P-interaction = 0.347
Adjusted for sex, age, body mass index, living area, smoking habits, drinking habits, comorbid conditions, working status, walking time, living status, subjective economic condition, psychological distress, and social isolation. OR: Odds ratio, CI: Confidence interval

Table 4. Association between preceding sleep disturbance and onset of neck pain.

	Sleep disturbance at the third point
	Total	Absence	Presence			P value
Participants without neck pain at the third point	1,647	1,178	469
Onset of neck pain at the fourth point, n (%)	174 (10.6)	88 (7.5)	86 (18.3)
Crude OR (95% CI)		1 (Ref.)	2.78 (2.02-3.83)			< 0.001
Adjusted OR (95%CI)		1 (Ref.)	2.47 (1.72-3.55)			< 0.001
				duration
			< 1 year	³ 1 year, < 2 years	³ 2 years	P for trend
Participants without neck pain at the third point			142	75	252
Onset of neck pain at the fourth point, n (%)			21 (14.8)	13 (17.3)	52 (20.6)
Crude OR (95% CI)		1 (Ref.)	2.15 (1.29-3.59)	2.60 (1.38-4.91)	3.22 (2.21-4.68)	< 0.001
Adjusted OR (95%CI)		1 (Ref.)	1.86 (1.08-3.20)	2.39 (1.22-4.70)	3.00 (1.94-4.65)	< 0.001
Adjusted for sex, age, body mass index, living area, smoking habits, drinking habits, comorbid conditions, working status, walking time, living status, subjective economic condition, psychological distress, and social isolation. OR: Odds ratio, CI: Confidence interval

No competing interests reported.

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Editorial decision: Major revision
05 Apr, 2022
Reviews received at journal
26 Mar, 2022
Reviewers agreed at journal
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Reviewers invited by journal
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Editor assigned by journal
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Editor invited by journal
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Submission checks completed at journal
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First submitted to journal
11 Mar, 2022

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Sleep disturbance is associated with neck pain: a 3-year longitudinal study after the Great East Japan Earthquake

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Abstract

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Background

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Neck pain

Sleep disturbance

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Statistical analysis

Results

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