The association of sleep-related issues with chronic pain and high-impact chronic pain incidence in U.S. adults: A 1-year representative cohort study

In this longitudinal cohort study, we used nationally representative data from the U.S. National Health Interview Survey (n = 7826 for chronic pain; n = 9195 for high-impact chronic pain [HICP]) to examine the association of trouble sleeping and tiredness with 1-year incidence of chronic pain and HICP in U.S. adults. We also evaluated group-specific estimates by age, sex, and race/ethnicity. The 1-year cumulative incidence of chronic pain was 10.6% (95% CI: 9.8–11.5%) and of HICP was 4.2% (95% CI: 3.7–4.8%). In adjusted models, individuals reporting trouble sleeping “more than half the days” had a 63% higher risk of chronic pain (RR = 1.63, 95% CI: 1.16–2.28) and a 101% higher risk of HICP (RR = 2.01, 95% CI: 1.29–3.13). Those reporting tiredness “nearly every day” had an 89% higher risk of chronic pain (RR = 1.89, 95% CI: 1.32–2.69) and 166% higher risk of HICP (RR = 2.66, 95% CI: 1.76–4.02). Stratified models revealed greater pain incidence in non-Hispanic/Latino (NH) Asian and NH Black or African American individuals with tiredness symptoms. Findings support addressing sleep and daily tiredness to prevent chronic pain, particularly in racially and ethnically minoritized populations. Perspective: Sleep disturbances and tiredness predict the development of both chronic pain and high-impact chronic pain one year later, even after stratifying by sociodemographic characteristics. Stratified analyses revealed important racial/ethnic disparities, highlighting the potential of addressing sleep-related mechanisms to prevent pain-related disability and reduce inequities in chronic pain outcomes.