1169 Association Between Sleep Disturbance and Pain-Related Outcomes Among Former Professional American-style Football Players

Introduction: Sleep disturbances and chronic pain frequently co-occur, exhibiting a bidirectional relationship that exacerbates both conditions. Former professional American-style football (ASF) players face unique health challenges from the physical demands and injuries sustained during their careers. This study investigates the associations between sleep disturbances and pain-related outcomes in this high-risk population.

Methods: This cross-sectional study analyzed data from 111 former professional ASF players enrolled in the Football Players Health Study at Harvard University. Sleep disturbance and sleep-related impairment were measured using PROMIS T-scores, while sleep-disordered breathing (SDB) was assessed using a single-night apnea-hypopnea index (AHI >15 events/hour). Pain outcomes included PROMIS pain interference T-scores and a 0–10 numeric rating scale for pain intensity. Weighted multivariable linear regression models were employed to evaluate associations, adjusting for demographics, physical activity, smoking status, football position, and number of professional seasons, to generalize findings to the broader Football Players Health Study cohort.

Results: The mean age of the former professional ASF players was 48.2 ± 7.8 years; 59 (53.2%) identified as Black, and 52 (46.8%) as White. The average duration of professional league play was 4.0 years, and 62 (55.9%) primarily played lineman positions. Higher PROMIS sleep disturbance scores were associated with higher pain interference (multivariable model β = 0.47; 95% CI: 0.16, 0.79; p < 0.01) and higher pain intensity (β = 1.03; 95% CI: 1.00, 1.06; p = 0.02). Similarly, sleep-related impairment scores were significantly associated with higher pain interference (β = 0.69; 95% CI: 0.43, 0.96; p < 0.001) and pain intensity (β = 1.05; 95% CI: 1.03, 1.07; p < 0.001). No significant associations were observed between SDB or higher rapid eye movement (REM) sleep percentage and pain intensity (β = 1.12, 95% CI: 0.70, 1.81, p = 0.63; β = 1.02, 95% CI: 0.98, 1.05, p = 0.34).

Conclusion: Patient-reported sleep disturbances and sleep-related impairment are significantly associated with higher pain interference and higher pain intensity among former professional ASF players. These findings underscore the opportunity for interventions to address sleep disturbances as part of comprehensive pain management strategies to reduce symptom burden and improve quality of life in this population.