Zhongguo quanke yixue (Apr 2022)
Effect of Sleep Time and Sleep Quality on the Risk of Low Back Pain among the Middle-aged and Elderly People in China
Abstract
BackgroundAs one of the disabling pains, low back pain seriously affects the quality of life of patients and causes a huge economic burden to them. Studies have shown that poor sleep quality has a certain effect on the occurrence of low back pain, but the dose-response relationship between sleep time and the risk of low back pain has been currently unclear, and there is a lack of relevant research in this area in China.ObjectiveTo explore the effect of sleep time and sleep quality on the risk of low back pain among the middle-aged and elderly people in China.MethodsUsing the longitudinal data of China Health and Retirement Longitudinal Study (CHARLS) between 2011 to 2015, all middle-aged and elderly people with a baseline age >45 year sat baseline from the three surveys in 2011, 2013, and 2015 were selected as the research subjects. The cut-off time of follow-up was 2015-12-31, and the self-reported low back and back pain was used as the outcome event, and follow-up was terminated upon the occurrence of the outcome event. Multivariate Cox proportional hazards regression analysis was used to assess the effect of sleep time and sleep quality on the risk of low back pain and the combined effect of them. Restricted cubic spline model was used to analyze the dose-response relationship between sleep time and the risk of low back pain.ResultsA total of 4 459 subjects were included, with an average follow-up of (3.6±0.8) years; sleep duration: <7 h/d in 1 549 subjects (34.74%) , 7-8 h/d in 1 843 subjects (41.33%) , ≥9 h/d in 1 067 subjects (23.93%) ; 2 700 people (60.55%) with good sleep quality and 1 759 people (39.45%) with impaired sleep quality. A total of 643 people developed low back pain, the incidence rate was 14.42% (643/4 459) . The prevalence of low back pain in middle-aged and elderly people with sleep time <7 h/d was higher than that in middle-aged and elderly people with sleep time of 7-8 h/d and ≥9 h/d 〔the prevalence rates were 20.92% (324/1 549 ) , 10.91% (201/1 843) and 11.06% (118/1 067) 〕 (P<0.05) . The prevalence of low back pain among middle-aged and elderly people with impaired sleep quality was higher than that of middle-aged and elderly people with good sleep quality 〔21.38% (376/1 759) and 9.89% (267/2 700) 〕 (P<0.05) . The multivariate Cox proportional hazards regression analysis showed that, compared with sleep time of 7-8 h/d, sleep time <7 h/d was the influential factor of low back pain 〔HR=1.63, 95%CI (1.37, 1.95) , P<0.05〕; compared with better sleep quality, impaired sleep quality was an influential factor of low back pain 〔HR=1.85, 95%CI (1.58, 2.17) , P<0.05〕; compared with male and female sleeping for 7-8 h/d, the risk of low back pain in male and female sleeping <7 h/d was 1.47 times 〔95%CI (1.09, 1.98) , P<0.05〕 and 1.76 times 〔95%CI (1.41, 2.20) , P<0.05〕.The data changed to 2.09 times 〔95%CI (1.60, 2.74) , P<0.05〕 and 1.73 times 〔95%CI (1.41, 2.11) , P<0.05〕 when comparing happened between impaired and good sleep quality (P<0.05) . Restricted cubic spline model analysis showed a linear dose-response relationship between sleep time and the risk of low back pain (Ptrend<0.05, Pnon-linear=0.33) , and the risk of low back pain increased with the decrease of sleep time. There was a linear dose-response relationship between sleep time and the risk of low back pain in male and female (male: Ptrend<0.05, Pnon-linear=0.66; female: Ptrend<0.05, Pnon-linear=0.23) , and the risk of low back pain in male and female increased with the decrease of sleep time (<7 h/d) .The multivariate Cox proportional hazards regression analysis showed that, only sleep time ≥9 h/d with good sleep quality was not associated with the risk of low back pain compared to sleep time 7-8 h/d with good sleep quality (P>0.05) , sleep time<7 h/d with good sleep quality, sleep time<7 h/d with impaired sleep quality, sleep time 7-8 h/d with impaired sleep quality, sleep time≥ 9 h/d with impaired sleep quality all increased the risk of low back pain (P<0.05) .ConclusionInsufficient sleep time and impaired sleep quality are closely related to the occurrence of low back pain, and the risk of low back pain is significantly increased when insufficient sleep time and impaired sleep quality coexist.
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