Abstract
Objective
Although sleep difficulties are common after spinal cord injury (SCI), little is known
about how day-to-day fluctuations in sleep quality affects health-related quality
of life (HRQOL) among these individuals. We examined the effect of sleep quality on
same-day HRQOL using ecological momentary assessment methods over a 7-day period.
Design
Repeated-measures study involving 7 days of home monitoring; participants completed
HRQOL measures each night and ecological momentary assessment ratings 3 times throughout
the day; multilevel models were used to analyze data.
Setting
Two academic medical centers.
Participants
A total of 170 individuals with SCI (N=170).
Interventions
Not applicable.
Main Outcome Measures
Daily sleep quality was rated on a scale of 0 (worst) to 10 (best) each morning. Participants
completed end-of-day diaries each night that included several HRQOL measures (Sleep
Disturbance, Sleep-related Impairment, Fatigue, Cognitive Abilities, Pain Intensity,
Pain Interference, Ability to Participate in Social Roles and Activities, Depression,
Anxiety) and ecological momentary assessment ratings of HRQOL (pain, fatigue, subjective
thinking) 3 times throughout each day.
Results
Multilevel models indicated that fluctuations in sleep quality (as determined by end-of-day
ratings) were significantly related to next-day ratings of HRQOL; sleep quality was
related to other reports of sleep (Sleep Disturbance; Sleep-related Impairment; Fatigue)
but not to other aspects of HRQOL. For ecological momentary assessment ratings, nights
of poor sleep were related to worse pain, fatigue, and thinking. Generally, sleep
quality showed consistent associations with fatigue and thinking across the day, but
the association between sleep quality and these ecological momentary assessment ratings
weakened over the course of the day.
Conclusions
Findings highlight the important association between sleep and HRQOL for people with
SCI. Future work targeting sleep quality improvement may have positive downstream
effects for improving HRQOL in people with SCI.
Keywords
List of abbreviations:
HRQOL (health-related quality of life), PROMIS (Patient-Reported Outcome Measurement Information System), SCI (spinal cord injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 17, 2021
Accepted:
July 10,
2021
Received in revised form:
July 2,
2021
Received:
November 4,
2020
Footnotes
Supported by a grant from the Craig H. Neilsen Foundation (award no. 440343). The content is solely the responsibility of the authors and does not necessarily represent the views of the Craig H. Neilsen Foundation. Also supported in part by the National Center for Advancing Translational Sciences (NCATS) for the Michigan Institute for Clinical and Health Research (grant no. UL1TR002240). Preliminary findings from this report are reported in Carlozzi NE, Boileau, NR, Molton I, et al. Self-reported sleep quality and same-day ratings of health-related quality of life in individuals with spinal cord injury (SCI). Arch Phys Med Rehabil 2019;100:E27.
Disclosures: Jonathan P. Troost has financial relationships with Proctor and Gamble and General Electric outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
