Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Graduate Group


First Advisor

Amy M. Sawyer


Chronic noncancer pain (CP) and sleep disorders are highly prevalent and impactful conditions among U.S. adults. Veterans, defined as adults who were discharged from previous active service in the United States (U.S.) military forces, are uniquely vulnerable to both sleep disorders and CP. Obstructive sleep apnea (OSA) ranks as the most common sleep disorder among veterans. Veterans experience greater prevalence and severity of CP than the general population. CP is also commonly reported among people with OSA. Current estimates indicate a high frequency of comorbid OSA and CP; however, no estimates are available in veterans. When CP and sleep disorders coexist, sleep is further disrupted, and worsened disability and quality of life outcomes may occur. In this context, this dissertation research: 1) systematically assessed the influence of sleep disturbances and sleep disorders on pain outcomes among veterans with CP (Chapter 2); 2) estimated the frequency of pre-existing CP (≥ 3 months) and multidimensionally characterize CP among veterans with OSA in terms of location, duration, severity, interference on daily activities, and type (neuropathic symptoms versus not) (Chapter 3); and, 3) examined differences in sleepiness (Epworth Sleepiness Scale [ESS]), insomnia symptoms (Insomnia Severity Index [ISI]), and quality of life (Short Form-20 health survey [SF-20]) in veterans with OSA with or without pre-existing CP (Chapter 4). An observational, cross-sectional study was conducted to characterize the frequency and type of CP and to assess differences in sleep and quality of life outcomes in veterans with OSA and with or without pre-existing CP. Results from this study indicate the importance of clinically prioritizing screening for and diagnosing OSA in CP conditions and recognizing the multiplicative symptom burden when OSA and CP co-exist that may or may not be fully ameliorated with OSA treatment. A highlight includes the importance of a research agenda that examines if a single, non-pharmacological treatment for OSA can improve CP outcomes in adults with comorbid OSA and CP.


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