Research has shown that pain and sleep disturbance often co-occur and influence each other over time in children and adolescents with chronic pain. Longitudinal studies examining the underlying mechanisms of this association are scarce and have focused primarily on the role of internalizing mental health symptoms and mood. This longitudinal study aimed to determine whether fatigue underlies the co-occurrence and mutual maintenance of sleep disturbance and pain over time in children and adolescents with chronic pain. Participants were 355 school-aged children and adolescents (mean age = 11.63 year old; 67% female) with chronic pain. The participants provided sociodemographic information and responded a survey that included measures of pain (duration, intensity, interference), sleep disturbance, and fatigue at first assessment and 12 months later. Partially latent, cross-lagged, panel, structural equation models revealed that sleep disturbance, pain intensity, and pain interference co-occurred at both time points. Higher levels of sleep disturbance, pain intensity, and pain interference at first assessment predicted higher levels of sleep disturbance, pain intensity, and pain interference at follow-up, respectively. Higher levels of pain interference at first assessment predicted higher levels of sleep disturbance at follow-up while controlling for initial levels of sleep disturbance. Furthermore, fatigue was found to mediate the association between first assessment and follow-up sleep disturbance, the association between first assessment and follow-up pain interference, and the association between first assessment pain interference and follow-up sleep disturbance. The findings highlight the need to assess and address fatigue in children and adolescents with chronic pain and sleep disturbance.

中文翻译：

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患有慢性疼痛的儿童和青少年的疲劳、睡眠障碍和疼痛干扰：一项纵向研究。


研究表明，患有慢性疼痛的儿童和青少年经常同时出现并随着时间的推移相互影响。检查这种关联的潜在机制的纵向研究很少，主要集中在内化心理健康症状和情绪的作用上。这项纵向研究旨在确定疲劳是否是患有慢性疼痛的儿童和青少年睡眠障碍和疼痛随着时间的推移同时发生和相互维持的基础。参与者是 355 名患有慢性疼痛的学龄儿童和青少年 （平均年龄 = 11.63 岁;67% 为女性）。参与者提供了社会人口学信息并回答了一项调查，其中包括在第一次评估和 12 个月后对疼痛（持续时间、强度、干扰）、睡眠障碍和疲劳的测量。部分潜伏、交叉滞后、面板、结构方程模型显示睡眠障碍、疼痛强度和疼痛干扰在两个时间点同时发生。首次评估时较高水平的睡眠障碍、疼痛强度和疼痛干扰分别预示着随访时较高水平的睡眠障碍、疼痛强度和疼痛干扰。第一次评估时较高水平的疼痛干扰预示着在控制初始睡眠障碍水平的同时，随访时睡眠障碍水平较高。此外，发现疲劳介导了首次评估与随访睡眠障碍之间的关联，首次评估与随访疼痛干扰之间的关联，以及首次评估疼痛干扰与随访睡眠障碍之间的关联。 研究结果强调了评估和解决患有慢性疼痛和睡眠障碍的儿童和青少年疲劳的必要性。