Sleep problems and psychological symptoms as predictors of musculoskeletal conditions in children and adolescents

BACKGROUND: Population-based studies show that sleep problems and psychological symptoms may increase the risk of musculoskeletal pain onset in children/adolescents. However, there is no evidence of these associations within primary care settings, where interventions can take place. This study investigated whether children/adolescents who consulted their general practitioner for sleep problems or psychological symptoms are at higher risk of subsequent consultations for musculoskeletal conditions. METHODS: This prospective matched-cohort study used electronic medical records of children/ adolescents (aged 6-19 years) from a UK primary care database. Associations between a consultation for sleep problems or psychological symptoms at baseline and a subsequent consultation for musculoskeletal conditions within the 2-year follow-up were investigated using survival analysis, producing hazard ratio (HR) and 95% confidence interval (CI) with adjustment for confounders. RESULTS: Children/adolescents who consulted for sleep problems had a significant increased risk of consultation for musculoskeletal conditions (HR = 1.72; 95% CI 1.14, 2.60), which became nonsignificant after adjustment for confounders (HR = 1.49; 95% CI 0.98, 2.27). Children/adolescents who consulted for psychological symptoms had a significant increased risk of consultation for musculoskeletal conditions (HR = 1.59; 95% CI 1.31, 1.93), which was attenuated after adjustment (HR = 1.39; 95% CI 1.14, 1.70). CONCLUSIONS: Children and adolescents who visit primary care for sleep problems or psychological symptoms have increased risk of future musculoskeletal consultations. Further work is needed to understand the causal mechanisms that explain these associations, before designing interventions strategies within primary care settings. SIGNIFICANCE: Population-based studies showed that sleep problems and psychological symptoms may be important precursors of musculoskeletal pain in children and adolescents. By investigating these associations in primary care settings, this study showed that children and adolescents with consultations for sleep problems or psychological symptoms were at increased risk of subsequent consultations for musculoskeletal conditions. These findings support results from population-based studies, and identify potential areas for further research and potential intervention within primary care.