Sleep Disturbance and Depression Symptoms Mediate the Relationship between Pain and Cognitive Dysfunction in Lupus Patients.

OBJECTIVE: The current study explored whether sleep disturbance and depression symptoms mediated the relationship between pain and Cognitive Dysfunction (CD) in a sample of 115 patients with Systemic Lupus Erythematosus (SLE).

METHODS: 115 consenting SLE patients completed questionnaires on pain, perceived stress, depression, sleep, and CD. Relationships among pain, sleep, depression and CD were assessed with bootstrapped mediation models controlling for race/ethnicity, fibromyalgia diagnosis, current corticosteroid use, disease activity and damage, and perceived stress.

RESULTS: Mediation analyses indicated that the effect of pain on CD was mediated by sleep disturbance (β = 0.30) and depression symptoms (β = 0.33). These effects were maintained even after controlling for aforementioned covariates, of which, only disease activity (β= 0.20) and stress (β=.22) remained significantly linked to CD [Overall Model R2 = .53; all p's <.05).

CONCLUSION: Even after controlling for disease activity and perceived stress, the relationship between pain and CD was explained by sleep disturbance and depression symptoms. Although these relationships need validation in longitudinal studies with additional measurement modalities, our findings may indicate promising, non-pharmacologic intervention avenues for SLE patients with pain and CD. Specifically, cognitive-behavioral therapies for depression and sleep are known to reduce distress and enhance functioning across various psychosocial domains. Given the symptom burden of SLE, interventions that maximize potential benefits without additional pharmacologic treatments may be of particular utility. This article is protected by copyright. All rights reserved.