The Joint Effects of Sleep and Pain, and Moderations by Work Characteristics

Graduation Year

2024

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

School of Aging Studies

Major Professor

Soomi Lee, Ph.D.

Co-Major Professor

Lindsay J. Peterson, Ph.D.

Committee Member

Brent J. Small, Ph.D.

Committee Member

Ross Andel, Ph.D.

Committee Member

Christina S. McCrae, Ph.D.

Committee Member

Katie L. Stone, Ph.D.

Keywords

Chronic conditions, Healthcare workers, Job demands, Job resources, Physical symptoms, Sleep duration

Abstract

Reactivity describes interindividual differences in the physiological or emotional responses following an antecedent stressor. For instance, higher stressor reactivity to shorter sleep (i.e., those who report greater stressor severity following shorter-than-usual sleep) and higher negative affective reactivity to stressors (i.e., those who report more negative affect following a stressful event) have worse mental and physical health. Pain reactivity to shorter sleep is a novel concept that describes differences in pain responses following a night of shorter-than-usual sleep. Higher pain reactivity to shorter sleep means that individuals report more pain locations or higher pain severity following shorter-than-usual sleep the previous night, whereas lower pain reactivity suggests that the individual does not report greater pain as a consequence of shorter-than-usual sleep. Aim 1 of this dissertation examined the associations between pain reactivity to shorter sleep and health outcomes measured by the risk of chronic conditions and depressive/distress symptoms among community-dwelling middle-aged and older adults. We hypothesized that higher pain reactivity would be associated with poorer health.

Moreover, considering the substantial role of work in defining middle and late adulthood and the recognition of existing health disparities in sleep and pain. Aim 2 of this dissertation assessed whether job demands and resources moderate the relationship between pain reactivity and health, and Aim 3 explored differences by age, sex, race/ethnicity, healthcare workers (HCWs) vs. non-HCWs, and shift work. HCWs were of interest because they provide direct patient care to the most vulnerable groups within society. Researchers have reported that HCWs are at higher risk of poorer sleep quality and more pain compared to the general population due to the emotional and physical tolls of their work. We hypothesized that more job demands would exacerbate the association between higher pain reactivity and poorer health and that more job resources would be protective. Aim 3 was exploratory with the purpose of examining differences by age, sex, race/ethnicity, HCW vs. non-HCW status, and shift work.

This dissertation leveraged data from the Midlife in the United States Study (MIDUS) and the Work, Family, and Health Study (WFHS). MIDUS is a U.S. longitudinal, nationally representative study with data collected between 2004 to 2006, and again from 2013 to 2014 (n = 2,016; Mage = 56.26 years). WFHS is a U.S.-based randomized control trial of HCWs and information technology workers with data collected in 2008 at baseline and 18 months from baseline (n = 311; Mage = 41.38 years). We used eight consecutive days of daily diary data to model next-day number of pain locations and pain severity regressed on previous night’s sleep duration (pain reactivity to shorter sleep). Cross-sectional and longitudinal analyses examined the influence of pain reactivity on health approximately 10 years later in MIDUS and 18 months later in WFHS. Analyses controlled for sociodemographic characteristics and health covariates (i.e., body mass index, smoking status, having an alcohol problem, and average physical activity). For Aim 2, composite scores for overall job demands, supervisor support, coworker support, and decision authority were examined. A series of modified Poisson regressions using PROC GENMOD and linear regressions using PROC GLM examined the risk of having chronic conditions and associations with depressive/distress symptoms, respectively. Comparative tests and interaction effects were used to probe group differences by sociodemographic characteristics and occupation types in the pain reactivity to health relation.

Results across MIDUS and WFHS were mixed. Lower pain severity reactivity to shorter sleep was associated with more depressive symptoms in MIDUS. Meanwhile, higher pain severity reactivity to shorter sleep was associated with more distress 18 months later in WFHS. Aim 2 revealed that job demands, supervisor support, and decision authority moderated the relationship between pain reactivity to shorter sleep and health outcomes, but findings differed between MIDUS and WFHS. Comparative tests revealed differences by sociodemographic characteristics and occupation types. Formal interaction tests revealed that sociodemographic characteristics and HCW status did not moderate the relation between pain reactivity to shorter sleep and health outcomes but shift work did. Novel contributions of this work include the modeling of pain reactivity to sleep among community-dwelling adults using a naturalistic study design; greater awareness of the importance of daily relations for long-term health; and new insights pointing at potential non-linear effects of daily sleep duration and work characteristics.

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