Chronic Low Back Pain and Sleep

Kelly GA et al. The Association Between Chronic Low Back Pain and Sleep: A Systematic Review. Clin J Pain: 2011

  • The aim of this study is to review the literature to determine whether an association between CLBP and sleep disturbance is present, the dimensions of sleep which may be affected by CLBP; and to determine whether and where further research in the area of CLBP and sleep is warranted.
  • Consistent evidence from 13 studies of moderate quality found CLBP was associated with sleep disturbance; resulting in generally reported disturbance, reduced total sleep time, and an increased number of awakenings and time spent awake after initial sleep onset. 
  • Consistent evidence from 5 moderate-quality studies found that poor sleep was adversely associated with day-time function in CLBP, with a significant decrease in day-time function; increase in day-time sitting, lying, and napping; pronounced sleepiness and exhaustion as a consequence of not sleeping properly; and increase in interference with daily function. 
  • Consistent evidence from 4 moderate-quality studies found LBP was associated with poor sleep quality (assessed by the valid and reliable PSQI and the Groninger Sleep Quality questionnaire), with depressed LBP patients displaying further reductions in sleep quality compared with nondepressed LBP patients.
  • Inconsistent evidence found that LBP patients reported reduced satisfaction and increased distress caused by problems with sleep. Greater than 50% of CLBP patients reported moderate-to-severe dissatisfaction with sleep, and reported significantly reduced sleep satisfaction at 7-year follow-up compared with individuals with no LBP. There was also a significant increase in distress caused by lack of sleep compared to controls with no history of LBP
  • Consistent evidence from 3 low-quality studies found that CLBP patients had difficulty falling asleep,52 and took significantly longer time compared with controls. Delayed sleep onset was related to higher pain intensity
  • Inconsistent evidence was found that CLBP patients recorded reduced sleep efficiency, two studies reported no difference in sleep efficiency between CLBP patients and controls when using actigraphy sleep monitors,whereas a third study reported significant decreases in sleep efficiency between CLBP patients compared with controls when assessed with the PSQI. More research is needed in this area. 
  • Inconsistent evidence was found for activity during sleep. Findings suggest that further research is necessary to assess whether CLBP is associated with greater movement during sleep and therefore less restful sleep.
  • Given the significant negative association between sleep and CLBP, improvement in sleep problems needs to be included in both assessment and management strategies to maximize patient care and improve their quality of life.