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Chronic low back pain and sleep disorders in older adults: a cross-sectional study Cover

Chronic low back pain and sleep disorders in older adults: a cross-sectional study

Open Access
|Mar 2026

References

  1. GBD 2016 Brazil Collaborators. Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10149):760–75. doi: 10.1016/S0140-6736(18)31221-2.
  2. de David CN, Deligne LMC, da Silva RS, Malta DC, Duncan BB, Passos VMDA, et al. The burden of low back pain in Brazil: estimates from the Global Burden of Disease 2017 Study. Popul Health Metr. 2020;18(Suppl 1):12. doi: 10.1186/s12963-020-00205-4.
  3. Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299. doi: 10.21037/atm.2020.02.175.
  4. IBGE. Censo 2010. Gov.br. [cited 2025 Aug 31]. Available from: https://censo2010.ibge.gov.br/.
  5. Carregaro RL, Tottoli CR, Rodrigues DS, Bosmans JE, da Silva EN, van Tulder M. Low back pain should be considered a health and research priority in Brazil: lost productivity and healthcare costs between 2012 to 2016. PLoS One. 2020;15(4):e0230902. doi: 10.1371/journal.pone.0230902.
  6. Silva S, Hayden JA, Mendes G, Verhagen AP, Pinto RZ, Silva A. Sleep as a prognostic factor in low back pain: a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials. Sleep. 2024;47(5): doi: 10.1093/sleep/zsae023.
  7. Alsaadi SM, McAuley JH, Hush JM, Lo S, Bartlett DJ, Grunstein RR, et al. The bidirectional relationship between pain intensity and sleep disturbance/quality in patients with low back pain. Clin J Pain. 2014;30(9):755–65. doi: 10.1097/AJP.0000000000000055.
  8. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539–52. doi: 10.1016/j.jpain.2013.08.007.
  9. Morelhão PK, Gobbi C, Christofaro DGD, Damato TM, Grande GD, Frange C, et al. Bidirectional association between sleep quality and low back pain in older adults: a longitudinal observational study. Arch Phys Med Rehabil. 2022;103(8):1558–64. doi: 10.1016/j.apmr.2021.11.009.
  10. Li J, Vitiello MV, Gooneratne NS. Sleep in normal aging. Sleep Med Clin. 2018;13(1):1–11. doi: 10.1016/j.jsmc.2017.09.001.
  11. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387–94. doi: 10.1378/chest.14-0970.
  12. Budhiraja R, Quan SF. Sleep-disordered breathing and cardiovascular health. Curr Opin Pulm Med. 2005;11(6):501–6. doi: 10.1097/01.mcp.0000183058.52924.70.
  13. Andrechuk CRS, Netzer N, Zancanella E, Almeida AR, Ceolim MF. Cultural adaptation and evaluation of the measurement properties of the Berlin Questionnaire for Brazil. Sleep Med. 2019;60:182–7. doi: 10.1016/j.sleep.2019.03.022.
  14. Lima CA, Soares WJS, Bilton TL, Dias RC, Ferrioll E, Perracini MR. Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study. Rev Bras Epidemiol. 2015;18(3):607–17. doi: 10.1590/1980-5497201500030007.
  15. Gooneratne NS, Weaver TE, Cater JR, Pack FM, Arner HM, Greenberg AS, et al. Functional outcomes of excessive daytime sleepiness in older adults. J Am Geriatr Soc. 2003;51(5):642–9. doi: 10.1034/j.1600-0579.2003.00208.x.
  16. Chiu YC, Hu HY, Lee FP, Huang HM. Tension-type headache associated with obstructive sleep apnea: a nationwide population-based study. J Headache Pain. 2015;16:34. doi: 10.1186/s10194-015-0517-5.
  17. Bigatti SM, Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008;59(7):961–7. doi: 10.1002/art.23828.
  18. Smith MT, Wickwire EM, Grace EG, Edwards RR, Buenaver LF, Peterson S, et al. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. Sleep. 2009;32(6):779–90. doi: 10.1093/sleep/32.6.779.
  19. Andersen ML, Araujo P, Frange C, Tufik S. Sleep disturbance and pain: a tale of two common problems. Chest. 2018;154(5):1249–59. doi: 10.1016/j.chest.2018.07.019.
  20. Charokopos A, Card ME, Gunderson C, Steffens C, Bastian LA. The association of obstructive sleep apnea and pain outcomes in adults: a systematic review. Pain Med. 2018;19(Suppl_1):S69–75. doi: 10.1093/pm/pny140.
  21. Steinmiller CL, Roehrs TA, Harris E, Hyde M, Greenwald MK, Roth T. Differential effect of codeine on thermal nociceptive sensitivity in sleepy versus nonsleepy healthy subjects. Exp Clin Psychopharmacol. 2010;18(3):277–83. doi: 10.1037/a0018899.
  22. Nelson KL, Davis JE, Corbett CF. Sleep quality: an evolutionary concept analysis. Nurs Forum. 2022;57(1):144–51. doi: 10.1111/nuf.12659.
  23. Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res. 2004;56(5):497–502. doi: 10.1016/j.jpsychores.2004.02.010.
  24. Roizenblatt S, Souza AL, Palombini L, Godoy LM, Tufik S, Bittencourt LRA. Musculoskeletal pain as a marker of health quality. Findings from the epidemiological sleep study among the adult population of São Paulo city. PLoS One. 2015;10(11):e0142726. doi: 10.1371/journal.pone.0142726.
  25. Caldas VVA, Zunzunegui MV, Freire ANF, Guerra RO. Translation, cultural adaptation and psychometric evaluation of the Leganés cognitive test in a low educated elderly Brazilian population. Arq Neuropsiquiatr. 2012;70(1):22–7. doi: 10.1590/s0004-282x2012000100006.
  26. MPA. Global strategy on diet, physical activity and health. Who.int. World Health Organization; 2004 [cited 2023 Aug 31]. Available from: https://www.who.int/publications/i/item/9241592222..
  27. Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003;49(2):156–63. doi: 10.1002/art.10993.
  28. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol. 2009;35(9):877–83. doi: 10.1590/s1806-37132009000900009.
  29. Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Miozzo ICS, de Barba MEF, et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011;12(1):70–5. doi: 10.1016/j.sleep.2010.04.020.
  30. Nimmaanrat S, Thepsuwan A, Tipchatyotin S, Jensen MP. Measuring pain intensity in older patients: a comparison of five scales. BMC Geriatr. 2024;24(1):556. doi: 10.1186/s12877-024-05127-6.
  31. Nusbaum L, Natour J, Ferraz MB, Goldenberg J. Translation, adaptation and validation of the Roland-Morris Questionnaire - Brazil Roland-Morris. Braz J Med Biol Res. 2001;34(2):203–10. doi: 10.1590/s0100-879x2001000200007.
  32. Hirotsu C, Bittencourt L, Garbuio S, Andersen ML, Tufik S. Sleep complaints in the Brazilian population: impact of socioeconomic factors. Sleep Sci. 2014;7(3):135–42. doi: 10.1016/j.slsci.2014.08.001.
  33. Castelo MS, Coelho-Filho JM, Carvalho AF, Lima JW, Noleto JC, Ribeiro KG, et al. Validity of the Brazilian version of the Geriatric Depression Scale (GDS) among primary care patients. Int Psychogeriatr. 2010;22(1):109–13. doi: 10.1017/S1041610209991219.
  34. Austin PC, Steyerberg EW. The number of subjects per variable required in linear regression analyses. J Clin Epidemiol. 2015;68(6):627–36. doi: 10.1016/j.jclinepi.2014.12.014.
  35. Adam Bujang M, Sa'at N, Bakar TMITA. Determination of minimum sample size requirement for multiple linear regression and analysis of covariance based on experimental and non-experimental studies. Epidemiol Biostat Public Health. 2022;14(3):e12117–1–e12117–9. doi: 10.2427/12117.
  36. Whibley D, AlKandari N, Kristensen K, Barnish M, Rzewuska M, Druce KL, et al. Sleep and pain: a systematic review of studies of mediation. Clin J Pain. 2019;35(6):544–58. doi: 10.1097/AJP.0000000000000697.
  37. Cappuccio FP, Taggart FM, Kandala NB, Currie A, Peile E, Stranges S, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619–26. doi: 10.1093/sleep/31.5.619.
  38. Nieminen LK, Pyysalo LM, Kankaanpää MJ. Prognostic factors for pain chronicity in low back pain: a systematic review. Pain Rep. 2021;6(1):e919. doi: 10.1097/PR9.0000000000000919.
  39. Pinheiro MB, Ferreira ML, Refshauge K, Maher CG, Ordoñana JR, Andrade TB, et al. Symptoms of depression as a prognostic factor for low back pain: a systematic review. Spine J. 2016;16(1):105–16. doi: 10.1016/j.spinee.2015.10.037.
  40. AlHarthi H, Bilal A, AlMalki H, Alzahrani F, Ibrahim A, Hussein H, et al. Variations in pain, disability, and psychosocial functioning among non-specific chronic low back pain patients with and without anxiety. Adv Rehab. 2025;39(1):33–45. doi: 10.5114/areh.2025.146633.
  41. França VL, Koerich MHADL, Nunes GS. Sleep quality of individuals with chronic low back pain. Fisioter Mov. 2015;28(4):803–10. doi: 10.1590/0103-5150.028.004.AO17.
  42. Oliveira SD, Pinto RZ, Gobbi C, Fernandes GL, Dokkedal-Silva V, Lemes ÍR, et al. Sleep quality predicts functional disability in older adults with low back pain: a longitudinal study. J Appl Gerontol. 2022;41(11):2374–81. doi: 10.1177/07334648221113500.
  43. Lin CWC, McAuley JH, Macedo L, Barnett DC, Smeets RJ, Verbunt JA. Relationship between physical activity and disability in low back pain: a systematic review and meta-analysis. Pain. 2011;152(3):607–13. doi: 10.1016/j.pain.2010.11.034.
  44. Machado LAC, Viana JU, da Silva SLA, Couto FGP, Mendes LP, Ferreira PH, et al. Correlates of a recent history of disabling low back pain in community-dwelling older persons: the pain in the elderly (PAINEL) study. Clin J Pain. 2018;34(6):515–24. doi: 10.1097/AJP.0000000000000564.
  45. Parsey CM, Schmitter-Edgecombe M, Belenky G. Sleep and everyday functioning in older adulthood. J Appl Gerontol. 2015;34(1):48–72. doi: 10.1177/0733464812458364.
  46. Chaput J-P, Dutil C, Sampasa-Kanyinga H. Sleeping hours: what is the ideal number and how does age impact this? Nat Sci Sleep. 2018;10:421–30. doi: 10.2147/NSS.S163071.
  47. Iacovides S, George K, Kamerman P, Baker FC. Sleep fragmentation hypersensitizes healthy young women to deep and superficial experimental pain. J Pain. 2017;18(7):844–54. doi: 10.1016/j.jpain.2017.02.436.
  48. Morelhão PK, Fernandes GL, Dokkedal-Silva V, Pires GN, Tufik S, Andersen ML. Musculoskeletal pain during the night and its relationship to sleep quality and poor sleep perception among older adults. Sleep Epidemiol. 2021;1(100006):100006. doi: 10.1016/j.sleepe.2021.100006.
  49. Baradaran Mahdavi S, Riahi R, Vahdatpour B, Kelishadi R. Association between sedentary behavior and low back pain; a systematic review and meta-analysis. Health Promot Perspect. 2021;11(4):393–410. doi: 10.34172/hpp.2021.50.
  50. Roberts MB, Drummond PD. Sleep problems are associated with chronic pain over and above mutual associations with depression and catastrophizing. Clin J Pain. 2016;32(9):792–9. doi: 10.1097/AJP.0000000000000329.
  51. Ernst G, Mariani J, Blanco M, Finn B, Salvado A, Borsini E. Increase in the frequency of obstructive sleep apnea in elderly people. Sleep Sci. 2019;12(3):222–6. doi: 10.5935/1984-0063.20190081.
  52. Aytekin E, Demir SE, Komut EA, Okur SC, Burnaz O, Caglar NS, et al. Chronic widespread musculoskeletal pain in patients with obstructive sleep apnea syndrome and the relationship between sleep disorder and pain level, quality of life, and disability. J Phys Ther Sci. 2015;27(9):2951–4. doi: 10.1589/jpts.27.2951.
  53. Onen S-H, Onen F, Albrand G, Decullier E, Chapuis F, Dubray C. Pain tolerance and obstructive sleep apnea in the elderly. J Am Med Dir Assoc. 2010;11(9):612–6. doi: 10.1016/j.jamda.2010.04.003.
  54. Sandberg JC, Grzywacz JG, Talton JW, Quandt SA, Chen H, Chatterjee AB, et al. A cross-sectional exploration of excessive daytime sleepiness, depression, and musculoskeletal pain among migrant farmworkers. J Agromedicine. 2012;17(1):70–80. doi: 10.1080/1059924X.2012.626750.
  55. Nadeem R, Bawaadam H, Asif A, Waheed I, Ghadai A, Khan A, et al. Effect of musculoskeletal pain on sleep architecture in patients with obstructive sleep apnea. Sleep Breath. 2014;18(3):571–7. doi: 10.1007/s11325-013-0920-6.
  56. Wilhelmsen M, Amirian I, Reiter RJ, Rosenberg J, Gögenur I. Analgesic effects of melatonin: a review of current evidence from experimental and clinical studies: analgesic effects of melatonin. J Pineal Res. 2011;51(3):270–7. doi: 10.1111/j.1600-079X.2011.00895.x.
  57. Ohayon MM, Vecchierini M-F. Daytime sleepiness and cognitive impairment in the elderly population. Arch Intern Med. 2002;162(2):201–8. doi: 10.1001/archinte.162.2.201.
  58. Park M, Buchman AS, Lim ASP, Leurgans SE, Bennett DA. Sleep complaints and incident disability in a community-based cohort study of older persons. Am J Geriatr Psychiatry. 2014;22(7):718–26. doi: 10.1016/j.jagp.2012.12.023.
  59. Foley D, Monjan A, Masaki K, Ross W, Havlik R, White L, et al. Daytime sleepiness is associated with 3-year incident dementia and cognitive decline in older Japanese-American men. J Am Geriatr Soc. 2001;49(12):1628–32. doi: 10.1046/j.1532-5415.2001.t01-1-49271.x.
  60. Morgan K, Hartescu I. Sleep duration and all-cause mortality: links to physical activity and prefrailty in a 27-year follow up of older adults in the UK. Sleep Med. 2019;54:231–7. doi: 10.1016/j.sleep.2018.11.008.
  61. Shiri R, Falah-Hassani K, Heliövaara M, Solovieva S, Amiri S, Lallukka T, et al. Risk factors for low back pain: a population-based longitudinal study. Arthritis Care Res (Hoboken). 2019;71(2):290–9. doi: 10.1002/acr.23710.
  62. McCracken LM, Iverson GL. Disrupted sleep patterns and daily functioning in patients with chronic pain. Pain Res Manag. 2002;7(2):75–9. doi: 10.1155/2002/579425.
  63. Pangaribuan SM, Wu TY, Herlianita R, Jao YL, Lee HC, Hasan F, et al. Global occurrence rates of sleep disturbances among institutionalized older adults: a systematic review and meta-analysis. Sleep Med Rev. 2025;81(102091):102091. doi: 10.1016/j.smrv.2025.102091.
  64. Jung NH, Lee CY. Subjective and objective health according to the characteristics of older adults: using data from a national survey of older Koreans. Medicine (Baltimore). 2024;103(47):e40633. doi: 10.1097/MD.0000000000040633.
Language: English
Page range: 87 - 103
Submitted on: Jul 16, 2025
Accepted on: Nov 4, 2025
Published on: Mar 31, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2026 Gabriel Mendes et al., published by Józef Piłsudski University of Physical Education in Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.