The role of sleep and circadian rhythms in intervertebral disc degeneration.

Abstract

Purpose: Low back pain is a globally prevalent disabling condition, with intervertebral disc degeneration (IDD) as a key inducer. Sleep abnormalities and circadian rhythm disorders are widespread, but their bidirectional associations with IDD and underlying pathophysiological mechanisms remain unclear. This narrative review synthesizes existing studies to clarify the mutual regulatory relationship and corresponding intervention strategies.

Methods: A structured literature search was conducted across PubMed, Embase and Web of Science from database inception through November 2025. Peer-reviewed original research and review articles were included, while conference abstracts, case reports, editorials and non-English manuscripts were excluded. Two independent reviewers performed title/abstract screening and full-text assessment, with discrepancies resolved by a third reviewer.

Results: Sleep and circadian disturbances promote IDD via five interconnected pathways: peripheral circadian clock disruption, mechanical/osmotic rhythm dysregulation, inflammation and oxidative stress imbalance, autophagy dysfunction, and hormonal rhythm dysregulation. Reciprocally, IDD further disrupts sleep homeostasis through pain signals, emotional-cognitive mediation and behavioral alterations, forming a vicious cycle. Three evidence-based interventions (CBT-I, exogenous melatonin and morning bright light therapy) exert dual benefits on sleep improvement and IDD alleviation.

Conclusion: Sleep and circadian rhythms drive a bidirectional vicious cycle with IDD and play a pivotal role in its progression. Future research should elucidate core clock gene-downstream pathway interactions, develop individualized regimens and expand longitudinal studies to support precision prevention and treatment of IDD and low back pain.