Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study

Abstract

Study Objectives: Pain symptoms, sleep disturbance, and daytime sleepiness are common in adolescents. This study examined the cross-sectional and prospective associations between pain symptoms and excessive daytime sleepiness (EDS) in a large sample of adolescents. Methods: Participants were 7,072 adolescents (mean age = 14.58 years) in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other general pain), body weight and height, sleep, anxiety/depression, substance use, and family environment in November–December in 2015 and 1 year later. The Chinese adolescent daytime sleepiness scale was used to measure daytime sleepiness. Results: Of the sample, 19.8% and 23.2% had moderate or severe EDS at baseline and at 1-year follow-up, respectively. The prevalence and 1-year incidence rates of EDS significantly increased with the frequencies of pain symptoms. Frequent pain was significantly associated with increased risk of EDS at baseline (odds ratio = 2.01, 95% confidence interval = 1.56–2.59), incident EDS (odds ratio = 1.41, 95% confidence interval = 1.03–1.93), and persistent EDS (odds ratio = 2.17, 95% confidence interval = 1.52–3.09) while adjusting for adolescent and family covariates, including anxiety/depression, nocturnal sleep duration, insomnia symptoms, frequent snoring, body mass index, and hypnotic use. Similar associations were observed across headache, stomachache, and other pain. Conclusions: Frequent pain is significantly and independently associated with increased risk of EDS. Our findings suggest that assessing and treating pain symptoms is important to improve healthy sleep and reduce risk of EDS in adolescents. Further research is needed to understand the underlying psychological and neurobiological mechanisms between pain and daytime sleepiness in adolescents.