Hao Jiang,1,* Xiaomin Zhang,2,* Jie Liang1 

1Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150081, People’s Republic of China; 2Department of Anesthesiology, Beidahuang Industry Group General Hospital, Harbin, Heilongjiang, 150000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jie Liang, Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 of Haping Road, Nangang District, Harbin, Heilongjiang, 150081, People’s Republic of China, Tel +86-13766864831, Email 830625@hrbmu.edu.cn

Purpose: To explore the combined effects of sleep disorders and depression on chronic low back pain (CLBP) in American adults.
Material and methods: In this cross-sectional study, the data of all participants were obtained from the National Health and Nutrition Examination Survey (NAHNES) between 2009 and 2010. CLBP was defined as persistent LBP for a consecutive three-month period. Sleep disorders were self-reported and were diagnosed by a doctor before. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms by trained personnel. Potential covariates were selected using weighted univariate logistic regression models. Weighted univariate and multivariate logistic regression models were used to evaluate the separate and combined effects of sleep disorders and depression on CLBP, respectively. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). Associations were further explored in the subgroups of age, chronic kidney disease (CKD), diabetes, and having pain outside the low back.
Results: A total of 5275 participants were included. Among them, 542 (10.28%) had CLBP. The mean age of all participants was 47.19 (0.53), and 50.65% (n=2668) were female. Sleep disorder (OR=1.52, 95% CI: 1.17– 1.98) or depressive symptoms (OR=3.06, 95% CI: 2.41– 3.88) were associated with higher odds of CLBP. Compared to participants without sleep disorders and depression symptoms, participants in both conditions had an increased risk of CLBP (OR=3.95, 95% CI: 2.58– 6.05, P for trend < 0.001). The combined effects of sleep disorders and depressive symptoms were also found in the population aged < 45 years, ≥ 45 years, with and without CKD, with and without diabetes, and no pain outside the low back.
Conclusion: Sleep disorders and depressive symptoms may increase the odds of reporting CLBP. Further research is necessary to explore the effectiveness of multidisciplinary interventions targeting sleep disorders, depressive symptoms, and CLBP.

Keywords: chronic low back pain, sleep disorders, depression, combined effect, the national health and nutrition examination survey