1025 Associations of Subjective and Objective Sleep Quality with Pain and Depression Among Adults with Fibromyalgia

Abstract Introduction Fibromyalgia (FM) is a chronic pain condition that affects 2-4% of Americans, particularly women of middle age. FM is marked by widespread pain and usually by difficulties sleeping and mood problems, such as depression. Pain and sleep problems are thought to exacerbate each other. Although pain is typically assessed by self-report, sleep quality can be assessed both subjectively and objectively, such as with sleep actigraphy. How these measures of sleep relate to pain and depression in people with FM is unclear, and subjective reports of sleep may be more biased by affective state than objective reports. Methods Our study investigated 194 adults with FM (94% female, 78% White, age M = 49.67, SD = 12.14). We assessed self-reported daily pain (14-day average; sample M = 5.18 on 0-10 scale), self-reported depressive symptoms (CES-D; M = 21.04, SD = 11.79 ), self-reported subjective sleep problems (Pittsburgh Sleep Quality Index; M = 12.51, SD = 4.18), and objective sleep efficiency (SE: amount of sleep divided by time-in-bed; M = 82.14%, SD = 7.57) using an Actiwatch, which participants wore continuously through a 2-week period. We ran Pearson correlations between pain and both objective and subjective sleep measures, before and after controlling for depressive symptoms. Results Greater subjective sleep problems were significantly (p<.05) correlated with lower objective SE (r = -.18), and greater pain was significantly correlated with greater subjective sleep problems (r = .31) and lower objective SE (r = -.20). Depressive symptoms were correlated with greater pain (r = .21) and poorer subjective sleep (r = .50), but not with objective SE (r = .07). After controlling for depression, pain was no longer correlated with subjective sleep problems (pr = .07) but remained marginally (p < .10) correlated with objective SE (pr = -.13). Conclusion Results suggest that pain and sleep problems in FM are associated, but that the method of sleep assessment matters. Objective assessment of sleep via actigraphy may provide an index that is less confounded by negative affect, suggesting actigraphy may be a more valuable method of sleep assessment than self-report measures. Support (if any) Funding provided by NIH R01 AR057808