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Could poor sleep perception be associated with feeling pain at night in older adults? A cross-sectional study


Senescence generates repercussions on sleep, including increased difficulty to initiate and maintain sleep, more awakenings, diurnal naps, and a propensity to polyphasic sleep. These disorders appear to be more common in older individuals with musculoskeletal pain. In this sense, the relationship between sleep and pain is considered bidirectional. However, it is unclear in the literature whether feeling pain during the night could be associated with poor sleep perception.


To describe a measurement model that appropriately conveys the link between sleep and feeling pain at night.


A cross-sectional analysis was conducted, using a dataset from the 2015 São Paulo Epidemiological Sleep Study (EPISONO), including only individuals aged 60 years or more. The poor sleep quality construct was formed by the self-reported answers in the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Musculoskeletal pain was assessed by “Did you feel any pain during the night?” (possible answers: “Yes” or “No”). We used exploratory factor analysis and structural equation modelling to identify the significant variables.


A total of 152 older adults was analyzed in this study. The analysis of the subjective sleep variables explained 83% of the cumulative variance for the questionnaires. The second factor was composed by the scores in the PSQI and ISI questionnaires. Thus, as both the PSQI and ISI indicate poor perception of sleep or a high frequency of sleep complaints in proportion to their score, the resulting latent factor was labelled poor sleep perception. Poor sleep perception was positively correlated to scores in the PSQI (beta=0.71) and ISI (beta=0.95, p<0.001). Structural equation modelling showed that poor sleep perception was associated with feeling pain during at night (beta=0.29, p<0.005).


Our findings suggest that poor subjective sleep was associated with feeling pain at night in older adults. These results contribute for the improvement of future clinical evaluations of patients presenting musculoskeletal pain and sleep complaints and highlight the importance of considering both factors simultaneously during treatment.


Sleep, pain, sleep perception, older adults.


Área Clínica


Universidade Federal de São Paulo - São Paulo - Brasil


Priscila Kalil Morelhão, Guilherme L. Fernandes, Vinícius Dokkedal-Silva, Gabriel Natan Pires, Sergio Tufik, Monica Levy Andersen