Physical work exposure, chronic musculoskeletal pain and risk of insomnia: longitudinal data from the HUNT study, Norway

The bidirectional relationship between sleep problems and chronic musculoskeletal pain: a systematic review with meta-analysis

ABSTRACT

Chronic musculoskeletal pain and sleep problems/disorders exhibit a recognized bidirectional relationship; yet, systematic investigations of this claim, particularly in a prospective context, are lacking. This systematic review with meta-analysis aimed to synthesize the literature on the prospective associations between sleep problems/disorders and chronic musculoskeletal pain. A comprehensive search across 6 databases identified prospective longitudinal cohort studies in adults examining the relationship between sleep problems/disorders and chronic musculoskeletal pain. Random-effects meta-analyses, using the Hartung-Knapp adjustment for 95% confidence intervals (CIs), were conducted, and all results were presented as odds ratios (ORs). Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Including 16 articles from 11 study populations (116,746 participants), meta-analyses indicated that sleep problems at baseline may heighten the risk of chronic musculoskeletal pain in both short term (OR 1.64, 95% CI 1.01-2.65) and long term (OR 1.39, 95% CI 1.21-1.59). The evidence for different sleep problem categories was very uncertain. Chronic musculoskeletal pain at baseline may increase the risk of short-term sleep problems (OR 1.56, 95% CI 1.02-2.38), but long-term evidence was very uncertain. The impact of only local or only widespread pain on short-term sleep problems was very uncertain, whereas widespread pain may elevate the risk of long-term sleep problems (OR 2.0, 95% CI 1.81-2.21). In conclusion, this systematic review with meta-analysis suggests that sleep problems are associated with an increased risk of chronic musculoskeletal pain, but the bidirectional nature of this relationship requires further investigation.

Commuting time, working time, and their link to insomnia symptoms among Korean employees: A cross-sectional study

OBJECTIVE

Although commuting time is an extension of working hours, few studies have examined the relationship between commuting time and insomnia symptoms in relation to working time. Thus, this study investigated the relationship between commuting time and working time and their link to sleep disturbance.

METHODS

This study included employees with ≥35 weekly working hours (n = 30,458) using data from the Sixth Korean Working Conditions Survey conducted in Korea between October 2020 and April 2021. The association between commuting time (≤60, 61-120, and >120 minutes) and insomnia symptoms based on working hours (35-40, 41-52, and >52 h/wk) or shift work was investigated using survey-weighted logistic regression analysis.

RESULTS

Long commuting time (>120 min/d) combined with >52 working hours/week (OR: 7.88, 95% CI: 2.51-24.71) or combined with 41-52 h/wk (OR: 3.64, 95% CI: 2.15-6.14) was associated with a higher risk of insomnia symptoms compared with the reference group (working hours: 35-40 h/wk; daily commuting time: ≤60 minutes), after controlling for sex, age, socioeconomic factors, and work-related factors. Among shift workers, those with daily commuting time ≤60 minutes (OR: 1.71, 95% CI: 1.39-2.09), 61-120 minutes (OR: 2.63, 95% CI: 1.21-5.74), and >120 minutes (OR: 5.16, 95% CI: 2.14-12.44) had higher odds of insomnia symptoms than nonshift workers with ≤60 minutes daily commuting time.

CONCLUSION

Long working hours and shift work are associated with greater risk of insomnia symptoms.

Association between ergonomic risk exposures and insomnia symptoms: a mediation analysis of the 5th Korean working conditions survey

BACKGROUND

This study investigates the relationship between ergonomic risk exposures and insomnia symptoms, using data representative of Korea's general working population.

METHODS

Data from the 5th Korean Working Conditions Survey were used for this study. The eligible population (employees) for the current study was 37,026. Insomnia symptoms were estimated using the minimal insomnia symptom scale (MISS) questionnaire. Logistic regression analysis was conducted to explore the association between ergonomic risks and insomnia symptoms.

RESULTS

All the investigated ergonomic risks increased odd ratios (ORs) for insomnia symptoms: Tiring or painful positions (OR, 1.64; 95% CI, 1.43-1.88); lifting or moving heavy loads (OR, 2.33; 95% CI, 1.99-2.71); long periods of standing (OR, 1.47; 95% CI, 1.29-1.69); and repetitive hand or arm movements (OR, 1.46; 95% CI, 1.29-1.67). The mediated proportion of musculoskeletal pain was 7.4% (95% CI, 5.81-10.13), and the mediated proportion of feeling of exhaustion was 17.5% (95% CI, 5.81-10.13).

CONCLUSIONS

This study provides evidence for the relationship between ergonomic risks and insomnia symptoms, for which musculoskeletal pains and the feeling of exhaustion may be potential mediators.

The bidirectional association between chronic musculoskeletal pain and sleep-related problems: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis synthesizes the evidence on prospective bidirectional associations between sleep-related problems (SRP) and chronic musculoskeletal pain (CMP).

METHODS

A literature search for cohort studies available in the PubMed, Scopus, Web of Science, PsycINFO and Cochrane Library databases as of 19 July 2022 was performed. Pooled odds ratios and effect sizes were calculated through random effects meta-analysis. Subgroup and meta-regression analyses were performed to explore differences by follow-up time, proportion of each sex and mean age. The Meta-analysis Of Observational Studies in Epidemiology guidelines were strictly followed.

RESULTS

Twenty studies with a total of 208 190 adults (aged 34.4-71.7 years) were included, with 17 of them being used in the meta-analysis. Individuals with SRP at baseline had a 1.79-fold higher incidence (odds ratio [OR] = 1.79; 95% CI: 1.55, 2.08; I2 = 84.7%; P < 0.001) and a 2.04-fold higher persistence (OR = 2.04; 95% CI: 1.42, 2.94; I2 = 88.5%; P < 0.005) of CMP than those without SRP. In the subgroup analysis of the association between SRP and CMP, the longer the follow-up time of the studies, the higher the heterogeneity between them. In the corresponding meta-regression, no significant effect was observed for follow-up time, sex proportion or age. Individuals with CMP at baseline had a 2.02-fold higher incidence of SRP (OR = 2.02; 95% CI: 1.62, 2.53; I2 = 90.0%; P < 0.001) than those without CMP.

CONCLUSION

This study provides robust evidence concerning the longitudinal association between SRP and incidence-persistence of CMP in adults. In addition, the available prospective studies support the existence of a bidirectional relationship between CMP and SRP.

PROSPERO REGISTRATION NUMBER

CRD42020212360.

Mental health among patients with chronic musculoskeletal pain and its relation to number of pain sites and pain intensity, a cross-sectional study among primary health care patients

BACKGROUND

Chronic musculoskeletal pain (CMP) is characterised by pain related to the muscles or the joints with a duration of three months or more and is associated with high symptomatic burden in patients in primary health care. CMP is commonly associated with impaired mental health, which may affect the rehabilitation process. The primary aim of this study was to compare symptoms of anxiety, depression, fatigue, and insomnia in patients in primary health care with and without CMP. The secondary aim was to assess difference in mental health symptoms related to number of pain sites and pain intensity.

METHODS

This cross-sectional study was conducted in Trondheim, Norway. All patients aged 21-58 from randomly selected general practitioners (GPs) were invited to participate. Participants were classified into two groups according to presence of CMP. Symptoms of anxiety, depression, fatigue, and insomnia were assessed by the Hospital Anxiety and Depression Scale (HADS), Chalder Fatigue Questionnaire (CFQ), and Insomnia Severity Index (ISI), respectively, using an online survey system.

RESULTS

From the patient lists of six GPs, we included 969 patients. Mean age 46 years (SD: 10.1), and 517 reported CMP. CMP patients reported higher mean symptom score for anxiety (5.4 vs 3.7), depression (3.4 vs 2.0), fatigue (14.2 vs 11.2), and insomnia (8.1 vs 4.4), all p < 0.01 compared to no-CMP patients. Symptoms of impaired mental health increased with increasing number of pain sites and pain intensity (p < 0.001).

CONCLUSIONS

Primary health care patients with CMP reported significantly more symptoms of anxiety, depression, fatigue, and insomnia than patients without CMP. The higher number of pain sites and pain intensity, the more mental health symptoms, especially of anxiety. Primary health care personnel have to address mental health issues when treating patients with CMP.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT02020772, 25/12/2013).

Physical Activity Is Associated With Sleep Quality: Results of the ESSE-RF Epidemiological Study

Background and hypothesis

Physical activity (PA) is an important behavioral factor associated with the quality of life and healthy longevity. We hypothesize that extremely low and extremely high levels of daily PA (including occupational PA) may have a negative impact on sleep quality and psychological well-being.

Objective

The aim of the study is to investigate the association between the level and type of PA and sleep problems in adult population.

Materials and methods

The sample of the study consisted of the participants from the population-based cohort of The Epidemiology of Cardiovascular Risk Factors and Diseases in Regions of the Russian Federation Study (ESSE-RF). The data of three regions (Saint Petersburg, Samara, Orenburg), varying in geographic, climatic, socioeconomic characteristics, was included into analysis. The total sample consisted of 4,800 participants (1,600 from each region; 1,926 males, 2,874 females), aged 25–64. The level of PA was evaluated using three parameters: the type of PA at work, the frequency of an intensive/high PA including sport (times a week), the mean duration of leisure-time walking (minutes a day). The measures of sleep quality were sleep duration and the frequency of difficulty falling asleep, difficulty maintaining sleep, daytime sleepiness, and sleep medication use. PA and sleep characteristics were assessed by interview carried by the trained medical staff.

Results

When controlling for gender, age and socioeconomic status (SES) extremely high occupational PA was a significant risk factor for difficulty falling asleep three or more times a week [OR(CI95%) = 1.9(1.2–3.0), p = 0.003] while working in a sitting position or having moderate physical load at work were not associated with sleep characteristics. Having a high physical load six or more times a week was a risk factor for difficulty falling asleep controlling for gender, age and SES [OR(CI95%) = 1.9(1.4–3.4), p = 0.001]. The association between leisure-time walking and sleep characteristics was insignificant. Walking less than an hour a day was associated with increased depression scores (46.5 vs. 41.9%, p = 0.006).

Conclusion

High physical load at work and excessively frequent intensive PA are associated with difficulties initiating sleep and may represent a risk factor for insomnia.

Work-related and personal factors in shoulder disorders among electronics workers: findings from an electronics enterprise in Taiwan

BACKGROUND

The electronics industry is one of the largest global industries, and significant numbers of workers are engaged in this industry. Evidence suggests two associations, including one between ergonomic risks and shoulder disorders and another between psychological stress and psychological problems among workers in this industry. Investigations on ergonomic risks, psychological stress, and sex effects for shoulder disorders in this industry are limited. This study aimed to explore personal and work-related factors associated with shoulder disorders and to investigate the combined effect of similar ergonomic risk factors.

METHODS

In this cross-sectional study, 931 workers aged 20 to 58 from an electronics factory in Taiwan were recruited. A Nordic musculoskeletal questionnaire was used to assess shoulder symptoms. Sociodemographic factors and work-related factors, including psychological stress, were assessed. One hundred random sample workers with shoulder symptoms underwent a standardized clinical test for the evaluation of subacromial impingement syndrome. The ergonomic risks were assessed by the risk filter of 'upper limb disorders in the workplace', including repetition, posture, force, vibration, and duration of exposure.

RESULTS

The prevalence of shoulder symptoms was 30.5, and 19% of those with shoulder symptoms had subacromial impingement syndrome. In multivariable analyses, older age (adjusted odds ratio (aOR) = 1.37, 95% CI 1.01-1.86), repetition (aOR = 1.73, 95% CI 1.15-2.60) and posture (aOR = 1.85, 95% CI 1.10-3.11) were associated with shoulder symptoms. Regarding the gender effect, older age (aOR = 1.46, 95% CI 1.01-2.11), repetition (aOR = 1.64, 95% CI 1.00-2.68), posture (aOR = 1.89, 95% CI 1.01-3.52), and force (aOR = 1.68, 95% CI 0.99-2.85) were associated with shoulder symptoms in men, whereas posture (aOR = 2.12, 95% CI 0.99-4.57) was associated with symptoms in women.

CONCLUSIONS

This study implies that repetition and posture are important risk factors for shoulder disorders in the electronics industry. The risk exhibited sex differences, and force was more important for shoulder disorders in men. Such information is useful to help occupational health practitioners and policy makers conduct preventive programmes on shoulder disorders in this working population. Future longitudinal studies on work-related shoulder disorders are warranted.

Analysis of the evidence of related factors, associated conditions and at-risk populations of the NANDA-I nursing diagnosis insomnia

Objectives

To summarize evidence in the literature on the predictors of insomnia in adults and to determine correspondences with diagnostic indicators of the NANDA-I diagnosis Insomnia.

Methods

An integrative review performed in Pubmed, Virtual Health Library and CINAHL. Forty-eight articles published in Portuguese, English or Spanish from 2011 to 2018 were included. An analysis of correspondence between the predictors and the NANDA-I related factors and associated conditions for Insomnia was performed.

Results

There was a correspondence of the predictors found in this review with NANDA-I related factors and associated conditions, except for grieving and frequent naps during the day. Smoking, caffeine intake, dysfunctional sleep beliefs, obesity and caregiver role strain are possible new related factors; chronic illness is a possible new associated condition and individuals going through changes in marital status, economically disadvantaged, female gender, increasing age and night shift worker are possible new at-risk populations.

Conclusion

The predictors of insomnia that had a correspondence with the NANDA-I elements can support the evidence base of the nursing diagnosis. The predictors found without a correspondence with the diagnosis can be considered for inclusion in the NANDA-I classification, thereby supporting the clinical reasoning of nurses and students.

The Case for Comorbid Myofascial Pain-A Qualitative Review

Myofascial pain syndrome is widely considered to be among the most prevalent pain conditions, both in the community and in specialized pain clinics. While myofascial pain often arises in otherwise healthy individuals, evidence is mounting that its prevalence may be even higher in individuals with various comorbidities. Comorbid myofascial pain has been observed in a wide variety of medical conditions, including malignant tumors, osteoarthritis, neurological conditions, and mental health conditions. Here, we review the evidence of comorbid myofascial pain and discuss the diagnostic and therapeutic implications of its recognition.

Work-Related Mental Fatigue, Physical Activity and Risk of Insomnia Symptoms: Longitudinal Data from the Norwegian HUNT Study

OBJECTIVE/BACKGROUND

To examine the prospective association between work-related mental fatigue and risk of insomnia symptoms, and if leisure time physical activity modifies this association.

PARTICIPANTS

A total of 8,464 women and 7,480 men who participated in two consecutive surveys of the Norwegian HUNT study.

METHODS

The study comprises longitudinal data on persons who were vocationally active and without insomnia symptoms at baseline in 1995-1997. We used a modified Poisson regression model to calculate adjusted risk ratios (RRs) with a 95% confidence interval (CI) for insomnia symptoms at follow-up in 2006-2008 associated with work-related mental fatigue and leisure time physical activity at baseline.

RESULTS

Women and men who always experienced mental fatigue after a workday had RRs of insomnia symptoms of 2.55 (95% CI 1.91-3.40) and 2.61 (95% CI 1.80-3.78), respectively, compared to workers who never or seldom had this experience. There was no strong modifying effect of leisure time physical activity on this association, but workers who always experienced mental fatigue had a RR of insomnia symptoms of 3.17 (95% CI 2.28-4.40) if they reported low physical activity and a RR of 2.52 (95% 1.89-3.39) if they reported high physical activity.

CONCLUSION

This study shows that work-related mental fatigue, caused by high cognitive workload, is a strong risk factor for insomnia symptoms. There was no clear modifying effect of leisure time physical activity but workers who experienced excessive work-related fatigue accompanied by low physical activity had the highest risk of insomnia symptoms.

Effects of a brief workplace-centered consultation for employees with musculoskeletal pain on health outcomes: a prospective cohort study

Musculoskeletal (MSK) diseases affect a substantial proportion of the population. Specialist consultations were offered at the workplace for people with musculoskeletal (MSK)-complaints. We analyzed data on pain and well-being as well as health economic data at baseline. Lasting effects of the consultation were analyzed at a follow-up-interview after 12 months. Baseline data of 344 individuals were available. Occupations were divided into physically highly demanding (HD) or less demanding. Women reported significantly higher pain levels and less QoL than men. Sick leave days were significantly more in HD-workers. Independent of workload, significantly higher percentages of women had cervical- and upper limb-pain than men, with significantly higher pain in upper limbs in HD-workers. 235 participants were available for telephone-follow-up. QoL and MSK-pain improved significantly. Yearly out-of-pocket spendings for treatments significantly increased. NSAID use significantly decreased, whereas use of non-drug musculoskeletal-medical-services was significantly higher after one year. Regarding MSK-symptoms in gainfully employed individuals, the study showed significantly different workload-dependent differences in QoL. Significant effects of a consultation by a MSK-specialist were shown in terms of improved MSK-pain and overall well-being. This workplace-centered consultation had significant effects on beneficial health-behavior such as decreased use of NSAID and increased engagement in gymnastics and physiotherapy.