{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:19:19Z","timestamp":1785766759399,"version":"3.56.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005416","name":"Norges Forskningsr\u00e5d","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004257","name":"Helse Vest","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004257","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> Previous research suggests a positive association between pain, depression and sleep. In this study, we investigate how sleep correlates with varying levels of pain and depression in nursing home (NH) patients with dementia.<\/jats:p><jats:p><jats:bold>Materials and methods:<\/jats:bold> Cross-sectional study (<jats:italic>n<\/jats:italic> = 141) with sleep-related data, derived from two multicenter studies conducted in Norway. We included NH patients with dementia according to the <jats:italic>Mini-Mental State Examination<\/jats:italic> (MMSE \u2264 20) from the COSMOS trial (<jats:italic>n<\/jats:italic> = 46) and the DEP.PAIN.DEM trial (<jats:italic>n<\/jats:italic> = 95) whose sleep was objectively measured with actigraphy. In the COSMOS trial, NH patients were included if they were \u226565 years of age and with life expectancy &amp;gt;6 months. In the DEP.PAIN.DEM trial, patients were included if they were \u226560 years and if they had depression according to the <jats:italic>Cornell Scale for Depression in Dementia<\/jats:italic> (CSDD \u2265 8). In both studies, pain was assessed with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and depression with CSDD. Sleep parameters were total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset (WASO), early morning awakening (EMA), daytime total sleep time (DTS) and time in bed (TiB). We registered use of sedatives, analgesics, opioids and antidepressants from patient health records and adjusted for these medications in the analyses.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Mean age was 86.2 years and 76.3% were female. Hierarchical regressions showed that pain was associated with higher TST and SE (<jats:italic>p<\/jats:italic> &amp;lt; 0.05), less WASO (<jats:italic>p<\/jats:italic> &amp;lt; 0.01) and more DTS (<jats:italic>p<\/jats:italic> &amp;lt; 0.01). More severe dementia was associated with more WASO (<jats:italic>p<\/jats:italic> &amp;lt; 0.05) and TiB (<jats:italic>p<\/jats:italic> &amp;lt; 0.01). More severe depression was associated with less TST (<jats:italic>p<\/jats:italic> &amp;lt; 0.05), less DTS (<jats:italic>p<\/jats:italic> &amp;lt; 0.01) and less TiB (<jats:italic>p<\/jats:italic> &amp;lt; 0.01). Use of sedative medications was associated with less TiB (<jats:italic>p<\/jats:italic> &amp;lt; 0.05).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> When sleep was measured with actigraphy, NH patients with dementia and pain slept more than patients without pain, in terms of higher total sleep time. Furthermore, their sleep efficiency was higher, indicating that the patients had more sleep within the time they spent in bed. Patients with more severe dementia spent more time awake during the time spent in bed. Furthermore, people with more severe depression slept less at daytime and had less total sleep time Controlling for concomitant medication use did not affect the obtained results.<\/jats:p>","DOI":"10.3389\/fpsyg.2021.633959","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T06:28:35Z","timestamp":1618900115000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Sleep and its Association With Pain and Depression in Nursing Home Patients With Advanced Dementia \u2013 a Cross-Sectional Study"],"prefix":"10.3389","volume":"12","author":[{"given":"Kjersti Marie","family":"Blytt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Flo-Groeneboom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ane","family":"Erdal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rn","family":"Bjorvatn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina S.","family":"Husebo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.pain.2009.10.008","article-title":"Pain in European long-term care facilities: cross-national study in Finland, Italy and The Netherlands.","volume":"148","author":"Achterberg","year":"2010","journal-title":"Pain"},{"key":"B2","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.2147\/CIA.S36739","article-title":"Pain management in patients with dementia.","volume":"8","author":"Achterberg","year":"2013","journal-title":"Clin. Interv. Aging"},{"key":"B3","first-page":"864","article-title":"Sleep complaints among older general practice patients: association with depression.","volume":"55","author":"Almeida","year":"2005","journal-title":"Br. J. Gen. Pract."},{"key":"B4","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1016\/j.sleep.2009.07.004","article-title":"Sleep and its disorders in aging populations.","volume":"10","author":"Ancoli-Israel","year":"2009","journal-title":"Sleep Med."},{"key":"B5","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1016\/j.chest.2018.07.019","article-title":"Sleep disturbance and pain: a tale of two common problems.","volume":"154","author":"Andersen","year":"2018","journal-title":"Chest"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2433","DOI":"10.1001\/archinte.163.20.2433","article-title":"Depression and pain comorbidity: a literature review.","volume":"163","author":"Bair","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1097\/yco.0b013e32833111f9","article-title":"Management of agitation and aggression associated with Alzheimer\u2019s disease: controversies and possible solutions.","volume":"22","author":"Ballard","year":"2009","journal-title":"Curr. Opin. Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1159\/000313533","article-title":"A reliability and validity study of the cornell scale among elderly inpatients, using various clinical criteria.","volume":"29","author":"Barca","year":"2010","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1159\/000313533","author":"Blytt","year":"2019","journal-title":"Sleep in Nursing Home Patients: Clinical Assessment and the Effects of Pain Treatment on Sleep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1186\/s12877-017-0653-7","article-title":"Clinically significant discrepancies between sleep problems assessed by standard clinical tools and actigraphy.","volume":"17","author":"Blytt","year":"2017","journal-title":"BMC Geriatr."},{"key":"B11","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1002\/gps.4839","article-title":"Effects of pain treatment on sleep in nursing home patients with dementia and depression: a multicenter placebo-controlled randomized clinical trial.","volume":"33","author":"Blytt","year":"","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","first-page":"134","DOI":"10.3389\/fpsyg.2018.00134","article-title":"Long-term pain treatment did not improve sleep in nursing home patients with comorbid dementia and depression: a 13-week randomized placebo-controlled trial.","volume":"9","author":"Blytt","year":"","journal-title":"Front. Psychol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.jad.2016.05.027","article-title":"Late-life depression symptom dimensions and cognitive functioning in the Longitudinal Aging Study Amsterdam (LASA).","volume":"201","author":"Brailean","year":"2016","journal-title":"J. Affect. Disord."},{"key":"B14","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1517\/14728222.2014.855720","article-title":"An intricate relationship between pain and depression: clinical correlates, coactivation factors and therapeutic targets.","volume":"18","author":"Chopra","year":"2014","journal-title":"Expert. Opin. Ther. Targets"},{"key":"B15","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1038\/nrneurol.2012.53","article-title":"Assessment and treatment of pain in people with dementia.","volume":"8","author":"Corbett","year":"2012","journal-title":"Nat. Rev. Neurol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1097\/yco.0b013e32834bb9d4","article-title":"Depression in dementia: epidemiology, mechanisms, and treatment.","volume":"24","author":"Enache","year":"2011","journal-title":"Curr. Opin. Psychiatry"},{"key":"B17","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1007\/s40266-018-0546-2","article-title":"Efficacy and safety of analgesic treatment for depression in people with advanced dementia: randomised, multicentre, double-blind, placebo-controlled trial (DEP. PAIN. DEM).","volume":"35","author":"Erdal","year":"2018","journal-title":"Drugs Aging"},{"key":"B18","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jad.2017.04.038","article-title":"Associations between pain and depression in nursing home patients at different stages of dementia.","volume":"218","author":"Erdal","year":"2017","journal-title":"J. Affect. Disord."},{"key":"B19","doi-asserted-by":"publisher","first-page":"538","DOI":"10.2174\/1567205013666160602234932","article-title":"Joint occurrence of pain and sleep disturbances in people with dementia. a systematic review.","volume":"14","author":"Flo","year":"2017","journal-title":"Curr Alzheimer Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1007\/s40266-014-0222-0","article-title":"Effective pain management in patients with dementia: benefits beyond pain?","volume":"31","author":"Flo","year":"2014","journal-title":"Drugs Aging"},{"key":"B21","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1016\/j.amjmed.2010.01.014","article-title":"Pain\/depression dyad: a key to a better understanding and treatment of functional somatic syndromes.","volume":"123","author":"Goldenberg","year":"2010","journal-title":"Am. J. Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1016\/s1474-4422(14)70103-6","article-title":"Pain assessment in elderly adults with dementia.","volume":"13","author":"Hadjistavropoulos","year":"2014","journal-title":"Lancet Neurol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1007\/s00228-017-2384-2","article-title":"Prevalence of pain and pharmacological pain treatment among old people in nursing homes in 2007 and 2013.","volume":"74","author":"Hemmingsson","year":"2018","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"B24","doi-asserted-by":"crossref","first-page":"173","DOI":"10.3389\/fpsyt.2020.00173","article-title":"An actigraphy-based validation study of the sleep disorder inventory in the nursing home.","volume":"11","author":"Hjetland","year":"2020","journal-title":"Front. Psychiatry"},{"key":"B25","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/j.jamda.2018.11.006","article-title":"The effect of a multicomponent intervention on quality of life in residents of nursing homes: a randomized controlled trial (COSMOS).","volume":"20","author":"Huseb\u00f8","year":"2019","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"B26","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1186\/s13012-015-0310-5","article-title":"COSMOS\u2014improving the quality of life in nursing home patients: protocol for an effectiveness-implementation cluster randomized clinical hybrid trial.","volume":"10","author":"Husebo","year":"2015","journal-title":"Implement. Sci."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1002\/ejp.507","article-title":"The MOBID-2 pain scale: reliability and responsiveness to pain in patients with dementia.","volume":"18","author":"Husebo","year":"2014","journal-title":"Eur. J. Pain"},{"key":"B28","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1111\/j.1471-6712.2009.00710.x","article-title":"Pain in older persons with severe dementia. Psychometric properties of MOBID-2 Pain Scale in a clinical setting.","volume":"24","author":"Husebo","year":"2010","journal-title":"Scand. J. Caring Sci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jpainsymman.2006.10.016","article-title":"Mobilization-observation-behavior-intensity-dementia pain scale (MOBID): development and validation of a nurse-administered pain assessment tool for use in dementia.","volume":"34","author":"Husebo","year":"2007","journal-title":"J. Pain Symptom Manage"},{"key":"B30","doi-asserted-by":"publisher","first-page":"207","DOI":"10.2466\/pms.1997.85.1.207","article-title":"The actigraph data analysis software: I. A novel approach to scoring and interpreting sleep-wake activity.","volume":"85","author":"Jean-Louis","year":"1997","journal-title":"Percept. Mot. Skills"},{"key":"B31","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1016\/j.jpain.2011.03.003","article-title":"Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care.","volume":"12","author":"Kroenke","year":"2011","journal-title":"J. Pain"},{"key":"B32","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1080\/15402002.2010.487450","article-title":"\u201c\u2026Not just a minor thing, it is something major, which stops you from functioning daily\u201d: quality of life and daytime functioning in insomnia.","volume":"8","author":"Kyle","year":"2010","journal-title":"Behav. Sleep Med."},{"key":"B33","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/1471-2318-14-138","article-title":"Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools.","volume":"14","author":"Lichtner","year":"2014","journal-title":"BMC Geriatr."},{"key":"B34","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.1016\/S0140-6736(17)31363-6","article-title":"Dementia prevention, intervention, and care.","volume":"390","author":"Livingston","year":"2017","journal-title":"Lancet"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.5665\/sleep.3142","article-title":"Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography.","volume":"36","author":"Marino","year":"2013","journal-title":"Sleep"},{"key":"B36","first-page":"CD009178","article-title":"Pharmacotherapies for sleep disturbances in dementia.","volume":"11","author":"McCleery","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"B37","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1093\/geronb\/gbu162","article-title":"Changes in sleep predict changes in affect in older caregivers of individuals with alzheimer\u2019s dementia: a multilevel model approach.","volume":"71","author":"McCrae","year":"2016","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"B38","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.pain.2011.09.024","article-title":"The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis.","volume":"153","author":"Nicassio","year":"2012","journal-title":"Pain"},{"key":"B39","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1097\/01.jgp.0000192478.82189.a8","article-title":"Mapping scores onto stages: mini-mental state examination and clinical dementia rating.","volume":"14","author":"Perneczky","year":"2006","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1080\/13607863.2018.1481929","article-title":"Pain inconsistency and sleep in mid to late-life: the role of depression.","volume":"23","author":"Ravyts","year":"2018","journal-title":"Aging Ment. Health"},{"key":"B41","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1093\/sleep\/17.3.201","article-title":"Activity-based sleep\u2014wake identification: an empirical test of methodological issues.","volume":"17","author":"Sadeh","year":"1994","journal-title":"Sleep"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1097\/j.pain.0000000000000131","article-title":"Sleep and pain sensitivity in adults.","volume":"156","author":"Sivertsen","year":"2015","journal-title":"Pain"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1093\/sleep\/29.10.1353","article-title":"A comparison of actigraphy and polysomnography in older adults treated for chronic primary insomnia.","volume":"29","author":"Sivertsen","year":"2006","journal-title":"Sleep"},{"key":"B44","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/0006-8993(85)91350-2","article-title":"The suprachiasmatic nucleus of the human brain in relation to sex, age and senile dementia.","volume":"342","author":"Swaab","year":"1985","journal-title":"Brain Res."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1016\/s0531-5565(00)00191-1","article-title":"Circadian and sleep disturbances in the elderly.","volume":"35","author":"Van Someren","year":"2000","journal-title":"Exp. Gerontol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1016\/j.pain.2011.12.009","article-title":"Fear-avoidance model of chronic musculoskeletal pain: 12 years on.","volume":"153","author":"Vlaeyen","year":"2012","journal-title":"Pain"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2020.11.014","article-title":"How, why and where it hurts\u2014breaking down pain syndrome among nursing home patients with dementia: a cross-sectional analysis of the COSMOS trial.","author":"Wagatsuma","year":"2020","journal-title":"Pain Manag. Nurs."},{"key":"B48","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1017\/s1041610220000642","article-title":"The impact of sleep disturbances on care home residents with dementia: the SIESTA qualitative study.","volume":"32","author":"Webster","year":"","journal-title":"Int. Psychogeriatr."},{"key":"B49","doi-asserted-by":"crossref","first-page":"zsz251","DOI":"10.1093\/sleep\/zsz251","article-title":"Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis.","volume":"43","author":"Webster","year":"","journal-title":"Sleep"},{"key":"B50","year":"2019","journal-title":"Dementia Fact Sheet No. 362."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2021.633959\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T06:28:45Z","timestamp":1618900125000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2021.633959\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,20]]},"references-count":50,"alternative-id":["10.3389\/fpsyg.2021.633959"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2021.633959","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,20]]},"article-number":"633959"}}