Joint association of chronic pain and sleep patterns with cardiovascular diseases: a prospective study

TL;DR

This study finds that chronic pain and poor sleep together increase cardiovascular disease risk more than either alone.

Contribution

The study reveals additive interactions between chronic pain and sleep patterns in CVD risk.

Findings

Chronic pain and poor sleep independently increase CVD risk.

Additive interactions between chronic localized pain and poor sleep raise CVD and CHD risk.

Worsening sleep patterns increase CVD risk for the same level of chronic pain.

Abstract

Previous studies have analyzed chronic pain and poor sleep behaviors as independent risk factors of cardiovascular diseases (CVD) risk, without mutual adjustment. While chronic pain and poor sleep behaviors frequently co-occurred, the interactive and joint associations of those two factors with CVD risk remains poorly understood.

A total of 467,689 participants from the UK Biobank were deemed eligible for inclusion in the analysis. The main outcomes were the incidence of CVD and its components including coronary heart disease (CHD) and stroke. Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). First, we assessed the independent associations of chronic pain and sleep patterns with CVD risk, mutually adjusting for these exposures. Then, multiplicative and additive interactions of the different extent of chronic pain and sleep patterns with the CVD risk were examined. Based on the significant multiplicative or additive interaction, the joint association of coexisting the different extent of chronic pain and sleep patterns with the incidence of CVD was further estimated.

During a median follow-up of 16.20 years, 54,743 CVD cases occurred, including 39,478 CHD and 19,696 stroke cases. Chronic pain and sleep patterns were independently associated with increased risk of CVD, CHD and stroke (HR, 1.06–1.83) when they were mutually adjusted. Significant additive interactions existed between chronic localized pain (CLP) and the poor sleep pattern on CVD (relative excess risk due to interaction [RERI], 0.20; 95% CI, 0.02–0.37) and CHD risk (RERI, 0.22; 95% CI, 0.01–0.44). Compared with participants free of chronic pain and having a healthy sleep pattern, those with coexisting chronic widespread pain (CWP) and a poor sleep pattern had a 106% and 105% higher risk of CVD and CHD, respectively.

There were significant additive interactions between CLP and the poor sleep pattern in relation to the risk of CVD and CHD. Among participants experiencing the same extent of chronic pain, there was an increasing trend in the risk of CVD and CHD as sleep patterns deteriorated.

The online version contains supplementary material available at 10.1186/s12889-025-26145-y.

Figures