1088 Pain and Subjective-EEG Sleep Discrepancies in Community-Dwelling Older Adults: The Moderating Role of MCI and Depression

Abstract Introduction Subjective–objective sleep discrepancy (SOSD)—the mismatch between self-reported and objectively measured sleep—is common in community-dwelling older adults. Pain is also prevalent in this population and can impact sleep quality and sleep perception. In prior work, we found that pain, mild cognitive impairment (MCI), and depressive symptoms were each independently associated with SOSD. Since these conditions frequently co-occur in older adults, the present study examined whether MCI or depressive symptoms moderate the association between pain and SOSD. Methods Baseline data were analyzed from 160 community-dwelling older adults enrolled in three randomized clinical trials (NCT03959202; NCT05064007; NCT05935241). Sleep efficiency was measured using an in-home EEG device (Sleep Profiler™) and corresponding sleep diaries over two nights. The SOSD index was calculated as (objective—subjective)/objective. Pain behavior and depressive symptoms were measured using the PROMIS Pain questionnaire and the Geriatric Depression Scale. Montreal Cognitive Assessment scores between 18—25 indicated MCI. Multiple linear regression examined the association between pain behavior and the SOSD index. Moderation was tested in two separate models, each including an interaction term (Pain*MCI or Pain*Depressive Symptoms), adjusting for age, sex, education, BMI, and chronic conditions. Results Participants were 70.4±5.7 years old, 85.6% women, and 56.6% with MCI. On average, participants under-reported their sleep efficiency (SOSD index=0.65). In adjusted models, greater pain behavior was associated with a more negative SOSD index (β=−0.026, 95% CI:[−0.046, −0.006]), indicating over-reporting sleep efficiency relative to EEG. In moderation analyses, this tendency to over-report was diminished among participants with MCI (β=0.051, 95% CI:[0.014, 0.089]). In a separate model, depressive symptoms similarly weakened this tendency (β=0.006, 95% CI:[0.000, 0.012]). Conclusion Greater pain behavior is associated with over-reporting sleep efficiency compared to EEG measures, but the association is attenuated among older adults with MCI or depressive symptoms. Our findings suggest a complex interplay where pain may influence subjective sleep reporting most strongly in cognitively intact individuals or those without depression. Clinicians should consider the potential influence of pain, cognition, and mood collectively when interpreting self-reported sleep quality in older adults. Support (if any) The National Institute of Nursing Research (R00 NR016484) and the National Institute on Aging (R21AG078917; 1R01AG080613-01A1) supported this study.