Author(s)

Lyuhan Zhang ¹

Affiliation(s)

¹ School of Public Health, Chongqing Medical University, 400016, Chongqing, China

Corresponding Author

Lyuhan Zhang

ABSTRACT

Using data from five waves (2011–2020) of the China Health and Retirement Longitudinal Study, this study examined longitudinal associations between sleep characteristics and incident pain in 10,253 Chinese adults aged ≥45 years who were pain-free at baseline. Sleep measures included subjective quality, nighttime duration (short, healthy, long). Generalized linear mixed-effects models adjusting for demographic, lifestyle, and health-related covariates showed that poor sleep quality significantly increased the risk of future pain (adjusted OR=2.33, 95% CI: 2.20–2.47). Compared with healthy sleep (6–8 h), short sleep duration (<6 h) was associated with higher pain risk (OR=1.77, 95% CI: 1.67–1.88), while long sleep (>8 h) unexpectedly showed a lower risk (OR=0.84, 95% CI: 0.77–0.93). These associations remained consistent across head/neck, trunk, and limb pain. The findings suggest that poor sleep quality and insufficient nighttime sleep are robust predictors of future pain among middle-aged and older adults.

KEYWORDS

Sleep; Pain; Aging; Longitudinal study; CHARLS

CITE THIS PAPER

Lyuhan Zhang. The Role of Sleep Quality and Duration in the Development of Pain: A Prospective Cohort Study of Chinese Older Adults. Social Medicine and Health Management (2026). Vol. 7, No.1, 70-75. DOI: http://dx.doi.org/10.23977/socmhm.2026.070109.

REFERENCES

[1] Yuan, Q., Yue, X., Wang, M., et al. (2025) Association between pain, sleep and intrinsic capacity in Chinese older adults: Evidence from CHARLS. The Journal of Nutrition, Health and Aging, 29(3), 100466.
[2] Yongjun, Z., Tingjie, Z., Xiaoqiu, Y., et al. (2020) A survey of chronic pain in China. Libyan Journal of Medicine, 15(1), 1730550.
[3] Li, X., Zhu, W., Li, J., Huang, C. and Yang, F. (2021) Prevalence and characteristics of chronic Pain in the Chinese community-dwelling elderly: a cross-sectional study. BMC Geriatrics, 21(1), 534.
[4] Moldofsky, H. (2001) Sleep and pain. Sleep Medicine Reviews, 5(5), 385-396.
[5] Roehrs, T. and Roth, T. (2005) Sleep and pain: interaction of two vital functions. Seminars in Neurology, 25(1), 106-116.
[6] Finan, P.H., Goodin, B.R. and Smith, M.T. (2013) The association of sleep and pain: an update and a path forward. The Journal of Pain, 14(12), 1539-1552.
[7] Ong, J.C., Dawson, S.C., Taylor, H.L., et al. (2023) A Micro-Longitudinal Study of Naps, Sleep Disturbance, and Headache Severity in Women with Chronic Migraine. Behavioral Sleep Medicine, 21(2), 117-128.
[8] Lillie, A.K., Read, S., Mallen, C., Croft, P. and McBeth, J. (2013) Musculoskeletal pain in older adults at the end-of-life: a systematic search and critical review of the literature with priorities for future research. BMC Palliative Care, 12(1), 27.
[9] Zimmer, Z., Fraser, K., Grol-Prokopczyk, H. and Zajacova, A. (2022) A global study of pain prevalence across 52 countries: examining the role of country-level contextual factors. Pain, 163(9), 1740-1750.
[10] Cohen, S.P., Vase, L. and Hooten, W.M. (2021) Chronic pain: an update on burden, best practices, and new advances. The Lancet, 397(10289), 2082-2097.
[11] Miettinen, T., Sverloff, J., Lappalainen, O.P., Linton, S.J., Sipilä, K. and Kalso, E. (2022) Sleep problems in pain patients entering tertiary pain care: the role of pain-related anxiety, medication use, self-reported diseases, and sleep disorders. Pain, 163(7), e812-e820.
[12] Afolalu, E.F., Ramlee, F. and Tang, N.K.Y. (2018) Effects of sleep changes on pain-related health outcomes in the general population: A systematic review of longitudinal studies with exploratory meta-analysis. Sleep Medicine Reviews, 39, 82-97.
[13] Zhang, J., Lam, S.P., Li, S.X., Li, A.M. and Wing, Y.K. (2012) The longitudinal course and impact of non-restorative sleep: a five-year community-based follow-up study. Sleep Medicine, 13(6), 570-576.
[14] Naughton, F., Ashworth, P. and Skevington, S.M. (2007) Does sleep quality predict pain-related disability in chronic pain patients? The mediating roles of depression and pain severity. Pain, 127(3), 243-252.
[15] Edwards, R.R., Almeida, D.M., Klick, B., Haythornthwaite, J.A. and Smith, M.T. (2008) Duration of sleep contributes to next-day pain report in the general population. Pain, 137(1), 202-207.
[16] Petrov, M.E. and Lichstein, K.L. (2016) Differences in sleep between black and white adults: an update and future directions. Sleep Medicine, 18, 74-81.
[17] Amicucci, G., Salfi, F., D’Atri, A., Viselli, L. and Ferrara, M. (2021) The Differential Impact of COVID-19 Lockdown on Sleep Quality, Insomnia, Depression, Stress, and Anxiety among Late Adolescents and Elderly in Italy. Brain Sciences, 11(10), 10.
[18] Boardman, H.F., Thomas, E., Millson, D.S. and Croft, P.R. (2006) The natural history of headache: predictors of onset and recovery. Cephalalgia, 26(9), 1080-1088.
[19] Lyngberg, A.C., Rasmussen, B.K., Jørgensen, T. and Jensen, R. (2005) Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. European Journal of Epidemiology, 20(3), 243-249.
[20] Calhoun, A.H. and Ford, S. (2007) Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache, 47(8), 1178-1183.
[21] Smitherman, T.A., Walters, A.B., Davis, R.E., et al. (2016) Randomized Controlled Pilot Trial of Behavioral Insomnia Treatment for Chronic Migraine With Comorbid Insomnia. Headache, 56(2), 276-291.
[22] Kovacs, F.M., Seco, J., Royuela, A., et al. (2015) Patients with neck pain are less likely to improve if they experience poor sleep quality: a prospective study in routine practice. The Clinical Journal of Pain, 31(8), 713-721.
[23] Irwin, M.R., Straub, R.H. and Smith, M.T. (2023) Heat of the Night: Sleep Disturbance Activates Inflammatory Mechanisms and Induces Pain in Rheumatoid Arthritis. Nature Reviews Rheumatology, 19, 545-559.
[24] Roehrs, T.A. and Roth, T. (2017) Increasing presurgery sleep reduces postsurgery pain and analgesic use following joint replacement: a feasibility study. Sleep Medicine, 33, 109-113.
[25] Chen, W., Wang, J.P., Wang, Z.M., Hu, P.C. and Chen, Y. (2022) Association between sleep duration and chest pain in US adults: A cross-sectional study. Frontiers in Public Health, 10, 952075.
[26] Agmon, M. and Armon, G. (2014) Increased insomnia symptoms predict the onset of back pain among employed adults. PLoS ONE, 9(8), e103591.
[27] Yang, J., Liu, C., Wu, G. and Zhao, S. (2024) Association between nighttime sleep duration and quality with low back pain in middle-aged and older Chinese adults. Experimental Gerontology, 197, 112602.

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