Introduction: People with Spinal Cord Injury (SCI) report significantly more sleep disturbance than the general population, which has significant implications for function, rehabilitation outcomes and quality of life. This study examined the relationship between sleep problems, depression, pain and fatigue in adults with SCI. Method(s): Six hundred and twenty adults with SCI in a longitudinal survey of self-reported health completed the Medical Outcomes Study Sleep Scale (MOS-SS); Patient Health Questionnaire-9 (PHQ-9 (depression)); Brief Pain Inventory-7 (BPI-7); and Fatigue Severity Scale (FSS). The majority of participants were community dwelling, with 1.5% institutionalized. Pearson's correlations between the MOS-SS summary measure (Sleep Problems Index II), MOS-SS subscales (sleep disturbance, snoring, shortness of breath, sleep quantity, sleep adequacy, and daytime somnolence) and depression, pain and fatigue were examined. Hierarchical multiple regression analysis examined the relationship between sleep problems (dependent variable) and depression, pain and fatigue (independent variables) controlling for age, sex, level of injury, and completeness of injury. Result(s): Most correlations were statistically significant (p < 0.001). Additionally, depression (beta=.393), pain (beta=.269), and fatigue (beta=.098) all made unique statistically significant contributions (P < 0.05). Conclusion(s): This study found that depression, pain and fatigue, are significantly related to sleep problems in people with SCI. Although the cross-sectional nature of this analysis does not permit conclusions about causality, these findings are consistent with results of studies in the general population that found poor sleep is associated with more depression, pain, and fatigue. The strong association of each of these symptoms with poor sleep following SCI highlights the critical importance of routinely screening people with SCI for sleep problems in order to inform treatment decisions and better manage conditions co-morbid with SCI.
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Fogelberg, D. J., Forwell, S. J., Diab, K. J., Vitiello, M. V., & Amtmann, D. (2018). 1042 Sleep Problems are Associated with Depression, Pain and Fatigue in Adults with Spinal Cord Injury. Sleep, 41(suppl_1), A387–A387. https://doi.org/10.1093/sleep/zsy061.1041