Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Br J Anaesth. 2012 Nov;109(5):769-75. doi: 10.1093/bja/aes252. Epub 2012 Jul 24.
Major surgery is followed by pronounced sleep disturbances after traditional perioperative care potentially leading to prolonged recovery. The aim was to evaluate the rapid eye movement (REM) sleep duration and sleep architecture before and after fast-track hip and knee replacement with length of stay (LOS) <3 days. The primary endpoint was REM sleep duration on the first postoperative night compared with before operation.
Ten subjects (≥60 yr) receiving spinal anaesthesia and multimodal opioid-sparing postoperative analgesia for total hip or knee arthroplasty were included. Ambulatory polysomnography was performed one night before operation at home, continuously during hospitalization, and on the fourth postoperative night at home. Sleep staging was performed according to the American Academy of Sleep Medicine manual. Opioid use, pain, and inflammatory response (C-reactive protein) were also evaluated.
The mean LOS was 1.5 (1-2) days. The mean REM sleep time decreased from a mean of 18.2 (9.5-23.5)% of total sleep time to 1.2 (0-5.8)% on the first postoperative night (P=0.002); awake time increased from 19.1 (3.7-44.4)% to 44.3 (12.2-70.6)% (P=0.009); and sleep architecture on the first postoperative night was more disturbed than before operation. Sleep architecture normalized on the fourth postoperative night. There was no association between opioid use, pain scores, and inflammatory response with a disturbed sleep pattern.
Despite ultra-short LOS and provision of spinal anaesthesia with multimodal opioid-sparing analgesia, REM sleep was almost eliminated on the first postoperative night after fast-track orthopaedic surgery but returned to pre-admission levels when at home on the fourth postoperative night.
传统围手术期护理后，大手术会出现明显的睡眠障碍，可能导致恢复时间延长。本研究旨在评估快速康复骨科手术（住院时间＜3 天）前后快速眼动（REM）睡眠持续时间和睡眠结构，并比较术后第一晚与术前的 REM 睡眠持续时间。
纳入 10 例（≥60 岁）接受椎管内麻醉和多模式阿片类药物节约型术后镇痛的全髋关节或膝关节置换术患者。术前一晚在家中进行便携式多导睡眠图检查，在住院期间连续进行，术后第四晚在家中进行。睡眠分期根据美国睡眠医学学会手册进行。还评估了阿片类药物的使用、疼痛和炎症反应（C 反应蛋白）。
平均住院时间为 1.5（1-2）天。平均 REM 睡眠时间从术前的总睡眠时间的 18.2%（9.5-23.5%）减少到术后第一晚的 1.2%（0-5.8%）（P=0.002）；清醒时间从 19.1%（3.7-44.4%）增加到术后第一晚的 44.3%（12.2-70.6%）（P=0.009）；术后第一晚的睡眠结构更紊乱。第四晚的睡眠结构恢复正常。阿片类药物的使用、疼痛评分和炎症反应与睡眠模式紊乱之间没有关联。
尽管住院时间极短，且提供了椎管内麻醉和多模式阿片类药物节约型镇痛，但快速康复骨科手术后的第一晚 REM 睡眠几乎消失，但当患者在家中时，在术后第四晚恢复到术前水平。
