TY - JOUR
T1 - Preoperative sleep quality and adverse pain outcomes after total hip arthroplasty
AU - Bjurström, Martin F.
AU - Irwin, Michael R.
AU - Bodelsson, Mikael
AU - Smith, Michael T.
AU - Mattsson-Carlgren, Niklas
N1 - Funding Information:
This research was funded by Stiftelsen Olle Engkvist Byggmästare, the Skåne University Hospital Foundation, the Wallenberg Center for Molecular Medicine, The Knut and Alice Wallenberg Foundation, The Medical Faculty at Lund University, Region Skåne, the European Research Council, the Swedish Research Council, the Marianne and Marcus Wallenberg foundation, the Swedish Medical Association, and the Swedish federal government under the ALF agreement. The authors thank all anaesthesiologists, orthopaedic surgeons and nurse anaesthetists at the Department of Orthopedics, Hässleholm Hospital, who contributed to the data collection of the study.
Funding Information:
This research was funded by Stiftelsen Olle Engkvist Byggmästare, the Skåne University Hospital Foundation, the Wallenberg Center for Molecular Medicine, The Knut and Alice Wallenberg Foundation, The Medical Faculty at Lund University, Region Skåne, the European Research Council, the Swedish Research Council, the Marianne and Marcus Wallenberg foundation, the Swedish Medical Association, and the Swedish federal government under the ALF agreement.
Publisher Copyright:
© 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®
PY - 2021/8
Y1 - 2021/8
N2 - Background: Sleep disturbance is thought to aggravate acute postoperative pain. The influence of preoperative sleep problems on pain control in the long-term and development of chronic postsurgical pain is largely unknown. Methods: This prospective, observational study aimed to examine the links between preoperative sleep disturbance (Pittsburgh Sleep Quality Index, PSQI) and pain severity (Brief Pain Inventory, BPI) 6 months postoperative (primary outcome), objective measures of pain and postoperative pain control variables (secondary outcomes). Patients (n = 52) with disabling osteoarthritis (OA) pain undergoing total hip arthroplasty (THA) were included. Quantitative sensory testing (QST) was performed preoperatively on the day of surgery to evaluate pain objectively. Clinical data, as well as measures of sleep quality and pain, were obtained preoperatively and longitudinally over a 6-month period. Results: Preoperatively, sleep disturbance (i.e., PSQI score >5) occurred in 73.1% (n = 38) of THA patients, and pain severity was high (BPI pain severity 5.4 ± 1.3). Regression models, adjusting for relevant covariates, showed that preoperative PSQI score predicted pain severity 6 months postoperative (β = 0.091 (95% CI 0.001–0.181), p =.048, R2 = 0.35). Poor sleep quality was associated with increased pressure pain sensitivity and impaired endogenous pain inhibitory capacity (R2 range 0.14–0.33, all p's < 0.04). Moreover, preoperative sleep disturbance predicted increased opioid treatment during the first 24 hr after surgery (unadjusted β = 0.009 (95% CI 0.002–0.015) mg/kg, p =.007, R2 = 0.15). Conclusions: Preoperative sleep disturbance is prevalent in THA patients, is associated with objective measures of pain severity, and independently predicts immediate postoperative opioid treatment and poorer long-term pain control in patients who have undergone THA. Significance: Poor sleep quality and impaired sleep continuity are associated with heightened pain sensitivity, but previous work has not evaluated whether preoperative sleep problems impact long-term postoperative pain outcomes. Here, we show that sleep difficulties prior to total hip arthroplasty adversely predict postoperative pain control 6 months after surgery. Given sleep difficulties robustly predict pain outcomes, targeting and improving sleep may have salutary effects on postoperative pain reports and management.
AB - Background: Sleep disturbance is thought to aggravate acute postoperative pain. The influence of preoperative sleep problems on pain control in the long-term and development of chronic postsurgical pain is largely unknown. Methods: This prospective, observational study aimed to examine the links between preoperative sleep disturbance (Pittsburgh Sleep Quality Index, PSQI) and pain severity (Brief Pain Inventory, BPI) 6 months postoperative (primary outcome), objective measures of pain and postoperative pain control variables (secondary outcomes). Patients (n = 52) with disabling osteoarthritis (OA) pain undergoing total hip arthroplasty (THA) were included. Quantitative sensory testing (QST) was performed preoperatively on the day of surgery to evaluate pain objectively. Clinical data, as well as measures of sleep quality and pain, were obtained preoperatively and longitudinally over a 6-month period. Results: Preoperatively, sleep disturbance (i.e., PSQI score >5) occurred in 73.1% (n = 38) of THA patients, and pain severity was high (BPI pain severity 5.4 ± 1.3). Regression models, adjusting for relevant covariates, showed that preoperative PSQI score predicted pain severity 6 months postoperative (β = 0.091 (95% CI 0.001–0.181), p =.048, R2 = 0.35). Poor sleep quality was associated with increased pressure pain sensitivity and impaired endogenous pain inhibitory capacity (R2 range 0.14–0.33, all p's < 0.04). Moreover, preoperative sleep disturbance predicted increased opioid treatment during the first 24 hr after surgery (unadjusted β = 0.009 (95% CI 0.002–0.015) mg/kg, p =.007, R2 = 0.15). Conclusions: Preoperative sleep disturbance is prevalent in THA patients, is associated with objective measures of pain severity, and independently predicts immediate postoperative opioid treatment and poorer long-term pain control in patients who have undergone THA. Significance: Poor sleep quality and impaired sleep continuity are associated with heightened pain sensitivity, but previous work has not evaluated whether preoperative sleep problems impact long-term postoperative pain outcomes. Here, we show that sleep difficulties prior to total hip arthroplasty adversely predict postoperative pain control 6 months after surgery. Given sleep difficulties robustly predict pain outcomes, targeting and improving sleep may have salutary effects on postoperative pain reports and management.
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U2 - 10.1002/ejp.1761
DO - 10.1002/ejp.1761
M3 - Article
C2 - 33682177
AN - SCOPUS:85102885803
SN - 1090-3801
VL - 25
SP - 1482
EP - 1492
JO - European Journal of Pain (United Kingdom)
JF - European Journal of Pain (United Kingdom)
IS - 7
ER -