Understanding Longitudinal Relationships between Sleep and Menstrual Pain in Adolescents - Project Summary/Abstract Up to 25% of adolescent females experience severe recurrent menstrual pain, which can have consequential impact on their school attendance and activity performance. Unfortunately, current treatment strategies are suboptimal. Despite the high prevalence of menstrual pain, there has been little attention directed toward developing effective therapies. Sleep deficiency and pain symptoms share a bidirectional relationship; and sleep deficiency is a risk factor for the development and maintenance of pain. During pubertal maturation, there are concurrent biological and psychosocial changes that can lead to sleep deficiency, including short sleep duration and insomnia symptoms, that are heightened by the discrepancy between adolescents’ internal circadian rhythm and social clock. In particular, post-pubertal females have been shown to develop higher rates of sleep deficiency compared to males. Moreover, depressive symptoms are also exacerbated by sleep impairments, that follows a precipitous rise during puberty. Therefore, the objective of this proposal is to understand the causal relationships between sleep deficiency and menstrual pain during pubertal maturation, and the daily and longitudinal impact on activity limitations. Using a comprehensive multi-method assessment protocol to measure sleep patterns in 13-16 year old adolescent females across the different phases of the menstrual cycle, our aims are to (1) compare sleep patterns and psychological mechanisms across the different phases of the menstrual cycle, (2) determine the mediating role of psychological factors in the daily associations between sleep deficiency with pain and functioning, and (3) identify the longitudinal relationships between sleep deficiency, pain, and daytime functioning over 12 months. This study utilizes a longitudinal cohort-sequential design to maximize data collection. We will enroll 200 female adolescents of 4 age cohorts (13, 14, 15, and 16 years) recruited from the community. All study procedures will be conducted remotely. At each time point (baseline, 4-, 8-, 12-months), adolescents will complete a 30-day ecological momentary assessment with daily symptom diary and continuous actigraphy monitoring of sleep and activity levels, as well as survey measures assessing sleep deficiency, pain, and psychological factors. The analytic plan will use latent curve modeling to evaluate developmental processes by modeling mean trajectories of the outcome variables across 12-month measurement occasions while dynamic structural equation modeling will be used to focus on moment-to-moment, within-person dynamics such as variability. This innovative study focuses on a pivotal time of pubertal maturation for adolescent females, during which there is a convergence of risks for sleep deficiency, depression and menstrual pain. By elucidating modifiable biopsychosocial factors that may explain the severity and impact of menstrual pain in adolescents, interventions to treat severe menstrual pain and reduce its impact on daily functioning can be developed. Findings will inform a future clinical trial to evaluate a sleep intervention in adolescents with menstrual pain.
