Department of Pharmacy, Zhongshan Hospital Fudan University, Shanghai, China.
Department of Orthopedics, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai, 200032, Republic of China.
Sleep Breath. 2021 Sep;25(3):1231-1237. doi: 10.1007/s11325-020-02213-y. Epub 2020 Oct 12.
This study aimed to examine sleep quality and risk factors associated with sleep disturbance in patients undergoing total joint arthroplasty (TJA) managed with an enhanced recovery protocol from preoperatively until 12 weeks postoperatively in order to provide suggestions for improving the prevention and treatment of sleep disturbance in these patients.
The Chinese versions of the Pittsburgh Sleep Quality Index (CPSQI) and Epworth Sleepiness Scale (CESS) were used to evaluate sleep quality. Pain was measured by a visual analog scale (VAS). Neuropsychological status was also assessed, using the Center for Epidemiological Studies Depression Scale (CESD) and Zung Self-Rating Anxiety Scale (ZSAS).
Of 107 patients (66% women), the prevalence of sleep disturbance was as high as 60% preoperatively. CPSQI score significantly increased postoperatively from baseline to 2 weeks before decreasing rapidly to a lower level than preoperative baseline. CESS scores of postoperative weeks 1 and 2 increased significantly compared with baseline and decreased significantly after 4 weeks, and a positive correlation was found between CESS and CPSQI score. VAS score significantly decreased from baseline over all time points in the postoperative period. A good sleeper group was more likely to suffer from severe sleep disturbance after surgery than a poor sleeper group with a bigger increase of CPSQI score. Multivariate logistic regression analysis indicated that pain and anxiety were risk factors associated with postoperative sleep disturbance.
Sleep disturbance is highly prevalent among patients undergoing TJA. More attention and multimodal approaches with well-controlled pain, mental counseling, and possibly preemptive use of sleep medication may improve sleep quality in TJA patients to promote recovery.
本研究旨在探讨接受强化康复方案治疗的全关节置换术（TJA）患者的睡眠质量和与睡眠障碍相关的风险因素，从术前一直评估到术后 12 周，以便为改善这些患者的睡眠障碍预防和治疗提供建议。
采用匹兹堡睡眠质量指数（CPSQI）和 Epworth 嗜睡量表（CESS）中文版评估睡眠质量。疼痛采用视觉模拟评分法（VAS）测量。神经心理学状态采用流行病学研究中心抑郁量表（CESD）和zung 自评焦虑量表（ZSAS）评估。
107 例患者（66%为女性）中，术前睡眠障碍的患病率高达 60%。CPSQI 评分在术后从基线开始显著增加，2 周前迅速下降至低于术前基线水平。术后第 1 周和第 2 周的 CESS 评分与基线相比显著增加，4 周后显著下降，CESS 评分与 CPSQI 评分呈正相关。VAS 评分在整个术后期间均从基线显著下降。与睡眠质量差的患者相比，睡眠质量好的患者术后更易发生严重的睡眠障碍，CPSQI 评分增加幅度更大。多变量逻辑回归分析表明，疼痛和焦虑是与术后睡眠障碍相关的风险因素。
TJA 患者中睡眠障碍的发生率很高。更多的关注和多模式方法，包括控制疼痛、心理疏导，可能会改善 TJA 患者的睡眠质量，促进康复。
