Sleep disturbances and back pain : Systematic review and meta-analysis.

BACKGROUND: In today's society, sleep disturbances and back pain are both common problems which threaten health. Although some studies have focused on the effects of sleep disturbances on back pain, no meta-analysis has been done. The purpose of this study is to systematically review and perform a meta-analysis on the effects of sleep disturbances on back pain. METHODS: A literature search in PubMed, Scopus and EMBASE with keywords until June 2019 was performed. The eligible articles were evaluated qualitatively and the results were pooled using random effects. The publication bias and the degree of heterogeneity were examined. RESULTS: In all, 21 studies were included in the meta-analysis. Sleep disturbances were associated with back pain (odds ratio 1.52; confidence interval [CI] 1.37-1.68; P< 0.001). In men, the odds ratio was 1.49 (CI 1.34-1.65; P< 0.001). In women, the odds ratio was 1.56 (CI 1.33-1.81; P< 0.001). Begg's test (P= 0.856) and Egger test (P= 0.188) did not show any publication bias. A funnel plot and trim-and-fill method showed publication bias, and heterogeneity was also high. CONCLUSIONS: Sleep disturbance is associated with risk of back pain. Improving sleep can be a deterrent against back pain. Therefore, interventions to reduce sleep disturbances can help to improve health. On the other hand, the relationship between sleep disturbances and back pain can be two-sided, and back pain can also lead to sleep disturbances. Not only in view of the lifetime prevalence and the multifactorial impairments of those affected, but also in consideration of social and economic burdens, this issue will remain of considerable importance.