Nowakowski Sara, Levy-Meeks Melanie E, Dawson Darius B, Meers Jessica M, Stout-Aguilar Jacqueline S, Kilic Gokhan S, Borahay Mostafa A
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.
Department of Medicine, Baylor College of Medicine, Houston, Texas.
J Clin Sleep Med. 2020 Nov 15;16(11):1901-1908. doi: 10.5664/jcsm.8730.
To evaluate the association of preoperative sleep pattern with posthysterectomy pain perception and satisfaction with surgery.
This pilot study included women undergoing minimally invasive hysterectomy for benign conditions. Sleep quality, insomnia severity, and insomnia risk were assessed pre- and postoperatively via standard questionnaires. Total sleep time, wake after sleep onset, and sleep efficiency were measured before and after hysterectomy using daily sleep diaries and wrist-worn actigraphy. Pain perception and satisfaction with hysterectomy were assessed postoperatively. Repeated-measures analysis of variance, Pearson's correlation, and linear regression were used for analysis.
Twenty women participated; of them 16 had complete data and were analyzed. Total sleep time increased from 384 ± 102 minutes before to 468 ± 96 minutes after surgery (P = .023). Wake after sleep onset, a measure of sleep fragmentation, increased from 26 ± 15.1 minutes before to 52 ± 22.9 minutes after surgery (P = .014). Pearson's correlation showed preoperative total sleep time was inversely correlated with postoperative pain intensity (r = -.92, P = .01). Preoperative wake after sleep onset was positively correlated with postoperative pain intensity (r = .86, P = .008). Preoperative insomnia severity and insomnia risk were positively associated with postoperative pain and pain behaviors (β = 0.41, P < .05; β = 0.55, P < .01, respectively). Finally, preoperative sleep efficiency was positively associated with overall satisfaction with hysterectomy (β = 0.39, P < .05).
Sleep duration and fragmentation increase following hysterectomy. Shorter, more fragmented preoperative sleep is associated with greater postoperative pain intensity. Better preoperative sleep was associated with more satisfaction after hysterectomy. Further studies are needed to determine if preoperative sleep interventions such as cognitive behavioral therapy improve pain perception and satisfaction after hysterectomy.
评估术前睡眠模式与子宫切除术后疼痛感知及手术满意度之间的关联。
这项试点研究纳入了因良性疾病接受微创子宫切除术的女性。术前和术后通过标准问卷评估睡眠质量、失眠严重程度和失眠风险。使用每日睡眠日记和腕部活动记录仪在子宫切除术前和术后测量总睡眠时间、睡眠开始后觉醒时间和睡眠效率。术后评估疼痛感知和子宫切除术满意度。采用重复测量方差分析、Pearson相关性分析和线性回归进行分析。
20名女性参与研究；其中16名有完整数据并进行了分析。总睡眠时间从术前的384±102分钟增加到术后的468±96分钟（P = 0.023）。睡眠开始后觉醒时间（睡眠碎片化的一个指标）从术前的26±15.1分钟增加到术后的52±22.9分钟（P = 0.014）。Pearson相关性分析显示，术前总睡眠时间与术后疼痛强度呈负相关（r = -0.92，P = 0.01）。术前睡眠开始后觉醒时间与术后疼痛强度呈正相关（r = 0.86，P = 0.008）。术前失眠严重程度和失眠风险与术后疼痛及疼痛行为呈正相关（β = 0.41, P < 0.05；β = 0.55, P < 0.01）。最后，术前睡眠效率与子宫切除术总体满意度呈正相关（β = 0.39, P < 0.05）。
子宫切除术后睡眠时间和碎片化程度增加。术前睡眠时间较短且碎片化程度较高与术后疼痛强度较大有关。术前睡眠质量较好与子宫切除术后满意度较高有关。需要进一步研究以确定术前睡眠干预措施（如认知行为疗法）是否能改善子宫切除术后的疼痛感知和满意度。
