Sleep Characteristics in Patients with Whiplash-Associated Disorders: A Descriptive Study
SOURCE: Topics in Integrative Health Care 2012 (Dec 31); 3 (4)
Jay Greenstein, DC, CCSP, CGFI-L, CKTP, FMS; Barton Bishop, DPT, SCS, CKTI, TPI, CGFI-MP, CSCS; Jean Edward, RN, BSN; Allen Huffman, DC, CKTP, BS; Danielle Davis; Robert Topp, RN, PhD
Study Objectives: The purpose of this study was to explore sleep habits and characteristics of patients with whiplash-associated disorders (WAD) presenting at an outpatient, chiropractic clinic using the Medical Outcomes Study (MOS) Sleep Scale.
Methods: Fifty-one patients from an outpatient chiropractic and physical therapy clinic specializing in spinal rehabilitation participated in this cross-sectional, descriptive study. Data were collected using a descriptive survey, the Visual Analog Scale (VAS), the Neck Disability Index (NDI), and the self-administered 12-item MOS Sleep Scale. Data analysis included descriptive statistics to describe pain, disability, and sleep characteristics of the study sample, and computation of confidence intervals to determine differences in means of sleep characteristics between the non-WAD population (as determined by previous studies) and the study sample of WAD patients.
Results: Results indicate that when compared to normative values of the non-WAD population, the sample of WAD patients in this study presents with significantly greater measures of neck disability (NDI), neck pain (VAS), sleep disturbance, snoring, shortness of breath and headache, sleep somnolence and sleep problems index I and II. This sample also presents with significantly lower measures of optimal sleep when compared to the general population.
Conclusion: Consistent with previous research, findings from this study indicate that WAD patients have increased neck disability and pain, and poorer sleep outcomes, indicating the need for clinicians to assess sleep characteristics and incorporate interventions aimed at alleviating these symptoms when planning rehabilitation. Findings provide evidence for the need to further explore sleep disturbances among WAD patients to establish a stronger understanding of the course and prognosis of this condition.
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Introduction
Neck pain related to whiplash-associated disorders (WAD) constitutes a significant health issue that leads patients to seek medical care in chiropractic and other physical therapy, rehabilitative clinics. Studies have indicated that individuals experience multiple clinical manifestations of WADs that lead to chronicity including postural changes, disability, headache, fatigue, and sleep disturbances. [1-4] Although studies have shown that sleep disturbances occur as a result of chronic pain, few studies have explored the relationship between patients with WAD and sleep quality. [4-6]
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Sleep disturbances that commonly occur during the initial period following the whiplash injury include delayed sleep latency and poor sleep quality. [4] Symptoms such as neck pain and tension headaches related to WAD are known to worsen with extended periods of poor posture, such as during night-time sleeping, causing significant sleep disturbances. [7, 8] Alteration in sleep quality in patients with WAD also leads to poor prognosis and increased chronicity of the condition. In a prospective cohort study by Hendriks et al. factors related to poor recovery in patients with WAD included higher levels of somatization and sleep difficulties. [9] Additionally, in a comparative study exploring sleep quality in patients with mechanical insidious neck pain and whiplash-associated neck pain, Valenza et al. found that individuals experiencing the latter showed poorer sleep quality. [3] Results also indicated significant differences in sleep quality, sleep latency, sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction among WAD patients when compared to healthy controls. [3] Several studies have indicated that the use of neck support devices, such as cervical pillows for sleep, can lead to improved posture, reduce cervical pain, while consequently improving sleep quality and WAD outcomes. [10-13] Therefore, improving sleep quality through the use of supportive therapies may have an impact on alleviating WAD symptoms and improved prognosis of the condition. This provides evidence for the need for chiropractic management of chronic WAD symptoms, with an emphasis on addressing pain and sleep disturbances as part of the evaluation and treatment of patients with WAD neck pain. However, limited literature regarding the characteristics and quality of sleep among WAD patients in relation to chiropractic health and management of chronic WAD symptoms warrants the need for further research. [2-4] Therefore, the purpose of this cross-sectional, descriptive study was to explore sleep habits and characteristics of patients with WAD presenting at an outpatient, chiropractic clinic using the MOS Sleep Scale.
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