Quality of Sleep in Patients with Chronic Low Back Pain; Relationship of Sleep with Pain, Functional Status and Quality of Life

Öz

Aim: The objective of this study was to assess sleep quality in patients with chronic low back pain and to demonstrate the relationship between sleep quality and pain, functional status and quality of life, as well as the relationship between chronic back pain and depression. Material and Methods: This study included 100 patients with chronic low back pain(CLBP) and 100 healthy controls. Pain was evaluated with Visual Analog Scale, functional capacity with Roland Morris Disability Questionnaire ,sleep quality with Pittsburgh Sleep Quality Index (PUKI), life quality with Short Form-36 (SF-36) and depression status with Beck Depression Inventory (BDI). We used these self-report questionnaires to compare CLBP patients with healthy control group. Also, cross- correlation among the sleep disturbance and severity of CLBP, functional capacity, life quality and depression were evaluated. Results: PSQI score was higher in patients with CLBP than control group [The median PSQI was 4 (0-15) for the healthy controls and 5 (1-14) for the patients group, p=0.014]. Significant associations were found between PUKI and the severity of pain in night (p=0.005). In the patient group, the detailed categories of physical function, physical role, vitality, social functioning, pain and general health of the SF-36 were statistically significantly lower than control group (p<0.001, p<0.001, p=0.001, p<0.001, p<0.001, p<0.001 respectively). There was no statistically significant difference BDI between the two groups (p=0.074) but there was a positive correlation between PUKI and BDI scores in two groups (for both p<0.001). Conclusion: Sleep quality is poor in patients with chronic low back pain and it is associated with night pain intensity. Sleep quality was associated with depression and poor quality of life independently low back pain. In individuals with chronic low back pain, treatment for pain may also improve sleep quality and quality of life.

Anahtar Kelimeler

• Low Back Pain
• Sleep
• Quality Of Life
• Functional Status

Kronik Bel Ağrılı Hastalarda Uyku Kalitesi; Uykunun Ağrı, Fonksiyonel Durum ve Yaşam Kalitesi ile İlişkisi

Öz

Amaç: Kronik bel ağrılı hastalarda uyku kalitesini değerlendirmek ve uyku kalitesi ile ağrı, fonksiyonel durum ve yaşam kalitesi arasındaki ilişkiyi incelemek, ayrıca kronik bel ağrısı ile depresyon durumu arasındaki ilişkiyi ortaya koymaktır. Gereç ve Yöntemler: Çalışmaya kronik bel ağrılı 100 hasta ve 100 kas-iskelet ağrısı olmayan birey alındı.Bel ağrısı düzeyi Vizüel Analog Skala (VAS), fonksiyonel durum Roland Morris Özürlülük Ölçeği, uyku kalitesi Pittsburg Uyku Kalitesi Ölçeği (PUKI), sağlıkla ilişkili yaşam kalitesi Kısa Form -36(KF-36) ve depresyon durumu Beck Depresyon Ölçeği ile değerlendirildi. Bu değerlendirme ölçekleri ile gruplar karşılaştırılmıştır. Ayrıca uyku kalitesi ile ağrı şiddeti, fonksiyonel durum, yaşam kalitesi ve depresyon durumu arasındaki ilişki incelenmiştir. Bulgular: Kronik bel ağrılı hastaların PUKI skoru kontrol grubundan anlamlı olarak daha yüksekti. [PUKI ortancası hasta grubu 5 (1-14), kontrol grubu 4 (0-15), p=0.014].Uyku kalitesi ile VAS-gece arasında istatistiksel anlamlı ilişki saptandı (p=0.005). Hasta grubunda KF-36’nın fiziksel fonksiyon, fiziksel rol güçlüğü, canlılık, sosyal işlevsellik, ağrı ve genel sağlık algısı alt parametrelerinde kontrol grubuna göre istatistiksel anlamlı düşük puan saptandı (Sırasıyla p<0.001, p<0.001, p=0.001, p<0.001, p<0.001, p<0.001). İki grup arasında Beck Depresyon Ölçeği değerleri açısından istatistiksel anlamlı farklılık yoktu (p=0.074) ancak iki grupta da PUKI ile Beck Depresyon Ölçeği arasında pozitif yönde korelasyon bulundu (Her iki grup için p<0.001). Sonuç: Kronik bel ağrılı hastalarda uyku kalitesi daha düşüktür ve uyku kalitesi gece ağrısı ile ilişkilidir. Uyku kalitesi ağrıdan bağımsız olarak depresyon ve düşük yaşam kalitesi ile ilişkilidir. Kronik bel ağrısı olan bireylerde ağrıya yönelik tedavi, uyku kalitesi ve yaşam kalitesinde de iyileşme sağlayabilir

Anahtar Kelimeler

• Bel Ağrısı
• Uyku
• Yaşam Kalitesi
• Fonksiyonel Durum

Kaynakça

1. Goel V, Iron K, Williams J. Indicators of health determinants and health status. Patterns of HealthCare in Ontario, the ICES practice atlas. 1996: 5-26.
2. Altun N. Bel Ağrıları. In: Yazar T, Altun N, editor. Dejeneratif Omurga Hastalıkları Türk Omurga Cerrahisi Derneği Yayınları, 2007:347-372.
3. Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. Revista de saude publica. 2015;49.
4. Fast A. Low back disorders: conservative management. Archives of physical medicine and rehabilitation. 1988;69: 880-891.
5. Karaman S, Karaman T, Dogru S, Onder Y, Citil R, Bulut Y, Tapar H, Sahin A, Arici S, Kaya Z. Prevalence of sleep disturbance in chronic pain. Eur Rev Med Pharmacol Sci. 2014;18: 2475-2481.
6. O'Donoghue GM, Fox N, Heneghan C, Hurley DA. Objective and subjective assessment of sleep in chronic low back pain patients compared with healthy age and gender matched controls: a pilot study. BMC musculoskeletal disorders. 2009;10: 122.
7. Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. Journal of pain research. 2016;9: 457-467.
8. Börsbo B, Peolsson M, Gerdle B. Catastrophizing, depression, and pain: correlation with and influence on quality of life and health–a study of chronic whiplash-associated disorders. Journal of rehabilitation medicine. 2008;40: 562-569.

9. Sribastav SS, Peiheng H, Jun L, Zemin L, Fuxin W, Jianru W, Hui L, Hua W, Zhaomin Z. Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain. PeerJ. 2017;5: e3282
10. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17: 45-56.
11. Müller U, Duetz M, Roeder C, Greenough C. Condition-specific outcome measures for low back pain. European spine journal. 2004;13: 301-313.
12. Roland M, Fairbank J. The Roland–Morris disability questionnaire and the Oswestry disability questionnaire. Spine. 2000;25: 3115-3124.
13. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research. 1989;28: 193-213.
14. Ware JE, Kosinski M, Dewey JE, Gandek B. SF-36 health survey: manual and interpretation guide. Quality Metric Inc., 2000.
15. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of general psychiatry. 1961;4: 561-571.
16. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15: 376-381.
17. Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep and Breathing. 2008;12: 161-168.
18. Küçükdeveci AA, Tennant A, Elhan AH, Niyazoglu H. Validation of the Turkish version of the Roland-Morris Disability Questionnaire for use in low back pain. Spine. 2001;26: 2738-2743.
19. Ağargün MY, Kara H, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatri Derg. 1996;7: 107-115.
20. Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş AK. Form-36 (KF-36)’nın Türkçe versiyonunun güvenilirliği ve geçerliliği. İlaç ve tedavi dergisi. 1999;12: 102- 106.
21. Hisli N. Beck Depresyon Envanteri'nin psikiyatri hastalari için geçerligi.(A study on the validation of the BDI: Turkish sample of psychiatric outpatients). Psikoloji dergisi. 1988;21: 118-126.
22. Altan L, Aksoy MK. Kronik Ağrı Tanımı ve Epidemiyolojisi. Turkiye Klinikleri Journal of Physical Medicine Rehabilitation Special Topics. 2017;10: 229-233.
23. Alsaadi SM, McAuley JH, Hush JM, Maher CG. Prevalence of sleep disturbance in patients with low back pain. European spine journal. 2011;20: 737-743.
24. Alsaadi SM, McAuley JH, Hush JM, Lo S, Lin CWC, Williams CM, Maher CG. Poor sleep quality is strongly associated with subsequent pain intensity in patients with acute low back pain. Arthritis & Rheumatology. 2014;66: 1388-1394.
25. Küçükdeveci AA . Lomber Bölge Ağrılarında Son Durum Ölçekleri. In: Şendur ÖF , editor. Tanıdan Tedaviye Bel ağrıları. İstanbul: Akademi Yayınevi, 2013:51-65.
26. Marty M, Rozenberg S, Duplan B, Thomas P, Duquesnoy B, Allaert F, Rhumatologie SRdlSFd. Quality of sleep in patients with chronic low back pain: a case-control study. European spine journal. 2008;17: 839-844.
27. EZ H. Kronik Bel Ağrılı Hastalarda Ağrı ve Fonksiyonel Durumun Yaşam Kalitesi ve Uyku Kalitesi Üzerine Etkisi Mersin Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı ,TIpta Uzmanlık Tezi. 2010.
28. Artner J, Cakir B, Spiekermann J-A, Kurz S, Leucht F, Reichel H, Lattig F. Prevalence of sleep deprivation in patients with chronic neck and back pain: a retrospective evaluation of 1016 patients. Journal of pain research. 2013;6: 1.
29. Hong JH, Kim HD, Shin HH, Huh B. Assessment of depression, anxiety, sleep disturbance, and quality of life in patients with chronic low back pain in Korea. Korean journal of anesthesiology. 2014;66: 444-450.
30. Li Y, Zhang S, Zhu J, Du X, Huang F. Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study. Arthritis research & therapy. 2012;14: R215.
31. Batmaz I, Sarıyıldız MA, Dilek B, Bez Y, Karakoç M, Cevik R. Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatology international. 2013;33: 1039-1045.
32. Nordeman L, Thorselius L, Gunnarsson R, Mannerkorpi K. Predictors for future activity limitation in women with chronic low back pain consulting primary care: a 2-year prospective longitudinal cohort study. BMJ open. 2017;7: e013974.
33. Wang H-Y, Fu T-S, Hsu S-C, Hung C-I. Association of depression with sleep quality might be greater than that of pain intensity among outpatients with chronic low back pain. Neuropsychiatric disease and treatment. 2016;12: 1993.
34. Tennant A. Quality of life--a measure too far? Annals of the Rheumatic Diseases. 1995;54: 439.
35. Tavafian SS, Jamshidi A, Mohammad K, Montazeri A. Low back pain education and short term quality of life: a randomized trial. BMC musculoskeletal disorders. 2007;8: 21.
36. Morone G, Paolucci T, Alcuri M, Vulpiani M, Matano A, Bureca I, Paolucci S, Saraceni V. Quality of life improved by multidisciplinary back school program in patıents with chronic non-specific low back pain: a single blind randomized controlled trial. European journal of physical and rehabilitation medicine. 2011;47: 533-541.
37. Soysal M,Kara B,Arda MN. Assessment of physical activity in patients with chronic low back or neck pain. Turkish neurosurgery. 2013;23: 75-80.