Ecological Momentary Assessment of Associations Between Sleep Quality, Stress, and Pain Among Women in Midlife with Risk for Cardiovascular Disease

Women in midlife (ages 40–60) are at elevated risk of developing cardiovascular disease (CVD), and daily experiences such as stress, physical pain, and poor sleep quality exacerbate this risk. Understanding the severity and temporal sequencing of these experiences as they occur in daily life will inform health promotion efforts for this vulnerable group. To achieve these goals, we used ecological momentary assessment to clarify the occurrence, severity, and temporal associations between momentary stress and pain, and tested for moderating effects of subjective sleep quality on these associations. Participants were 75 women in midlife with >1 risk factors for CVD (mean age = 52 years, mean BMI = 34.0 kg/m²) who completed 10 days of assessment. Multilevel models showed considerable within-person variability in sleep quality and stress. Pain was reported at 32% of moments and showed within-person variability. Within-person, stress and pain were worse on days with poorer sleep; pain intensity was worse after times when stress was worse (vs. better), on days when sleep was poorer. Findings show that women experience considerable variability in their daily experiences of sleep quality, stress, and pain. Greater-than-usual stress may be a real-time marker of later pain, on days when sleep is worse than usual. This clarification of temporal sequencing in women’s daily lives may inform just-in-time interventions to mitigate pain.